Provider Demographics
NPI:1558652586
Name:J.BOLARAM,MD &ASSOCIATES,P.A
Entity Type:Organization
Organization Name:J.BOLARAM,MD &ASSOCIATES,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-214-3230
Mailing Address - Street 1:2643 WYNDSOR OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3080
Mailing Address - Country:US
Mailing Address - Phone:863-214-3230
Mailing Address - Fax:
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:SUITE A2
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-214-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME925602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty