Provider Demographics
NPI:1053528877
Name:DONALD J BOLES JR MD PC
Entity type:Organization
Organization Name:DONALD J BOLES JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-895-2010
Mailing Address - Street 1:9508 E RIGGS RD
Mailing Address - Street 2:STE MC263
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:480-895-2010
Mailing Address - Fax:480-883-2747
Practice Address - Street 1:9508 E RIGGS RD
Practice Address - Street 2:STE MC263
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-895-2010
Practice Address - Fax:480-883-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17193207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D43717Medicare UPIN
AZ81970Medicare PIN