Provider Demographics
NPI:1013228063
Name:BOLES, JOE D JR
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:D
Last Name:BOLES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3864 CENTER RD STE A2
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6600
Mailing Address - Country:US
Mailing Address - Phone:330-225-6800
Mailing Address - Fax:330-225-9911
Practice Address - Street 1:3864 CENTER RD STE A2
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6600
Practice Address - Country:US
Practice Address - Phone:330-225-6800
Practice Address - Fax:330-225-9911
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist