Provider Demographics
NPI:1639587173
Name:JASON M. BOLEY, MD., PLLC.
Entity Type:Organization
Organization Name:JASON M. BOLEY, MD., PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-703-8848
Mailing Address - Street 1:3550 NORMAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-703-8848
Mailing Address - Fax:979-703-6485
Practice Address - Street 1:3550 NORMAND DRIVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-703-8848
Practice Address - Fax:979-703-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty