Provider Demographics
NPI:1720215866
Name:BOLOUR, ADAM RAHIM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RAHIM
Last Name:BOLOUR
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 80007
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93912-0007
Mailing Address - Country:US
Mailing Address - Phone:831-755-4111
Mailing Address - Fax:831-755-4087
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4111
Practice Address - Fax:831-755-4087
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1019290Medicaid
CA94-6000524OtherITIN
CA94-6000524OtherITIN