Provider Demographics
NPI:1225038094
Name:BOLIN, DANIEL HUFFMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HUFFMAN
Last Name:BOLIN
Suffix:
Gender:M
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:PO BOX 97555
Mailing Address - Street 2:1208 BROOK
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-7555
Mailing Address - Country:US
Mailing Address - Phone:940-761-3333
Mailing Address - Fax:940-766-6302
Practice Address - Street 1:1208 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5602
Practice Address - Country:US
Practice Address - Phone:940-761-3333
Practice Address - Fax:940-766-6302
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE60422083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21364Medicare UPIN
TX8639M0Medicare ID - Type Unspecified