Provider Demographics
NPI:1629067335
Name:BOLDT, JOHN W JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BOLDT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11547
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2547
Mailing Address - Country:US
Mailing Address - Phone:423-778-3274
Mailing Address - Fax:423-778-2255
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE B-805
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-9101
Practice Address - Fax:423-778-4397
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN26336207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE24305Medicare UPIN
TN38921301Medicare PIN