Provider Demographics
NPI:1114031507
Name:BOLES, STEVEN C (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:BOLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 W THUNDEBIRD ROAD
Mailing Address - Street 2:STE. D-105
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4841
Mailing Address - Country:US
Mailing Address - Phone:623-849-3811
Mailing Address - Fax:623-849-5221
Practice Address - Street 1:9191 W THUNDERBIRD ROAD
Practice Address - Street 2:SUITE D-105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4841
Practice Address - Country:US
Practice Address - Phone:623-849-3811
Practice Address - Fax:623-849-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ254483Medicaid
AZC98157Medicare UPIN
AZC98157Medicare UPIN