Provider Demographics
NPI:1003076159
Name:BOLT, EVELYN YOH (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:YOH
Last Name:BOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 ROCKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8701
Mailing Address - Country:US
Mailing Address - Phone:773-742-1899
Mailing Address - Fax:
Practice Address - Street 1:13654 XAVIER LN
Practice Address - Street 2:SUITE 201B
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3606
Practice Address - Country:US
Practice Address - Phone:720-279-9098
Practice Address - Fax:720-540-4250
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051870207RP1001X, 207RS0012X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO370941YWN5OtherMEDICARE PTAN