Provider Demographics
NPI:1225390719
Name:BOLER, PATRICK LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYNN
Last Name:BOLER
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 1:815 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5252
Mailing Address - Country:US
Mailing Address - Phone:601-910-3004
Mailing Address - Fax:
Practice Address - Street 1:815 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5252
Practice Address - Country:US
Practice Address - Phone:601-910-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34725207R00000X
LAPGY..202111207N00000X
MS24316207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine