Provider Demographics
NPI:1093716102
Name:BOLTZ, PATRICIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 TIMBER WAY
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5682
Mailing Address - Country:US
Mailing Address - Phone:251-445-7225
Mailing Address - Fax:251-445-7226
Practice Address - Street 1:1 TIMBER WAY
Practice Address - Street 2:SUITE #203
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5682
Practice Address - Country:US
Practice Address - Phone:251-445-7225
Practice Address - Fax:251-445-7226
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL21886207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG64779Medicare UPIN
AL90004Medicare PIN