Provider Demographics
NPI:1760491179
Name:BOLING, M TODD (DO)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:TODD
Last Name:BOLING
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:35477 KENAI SPUR HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7625
Mailing Address - Country:US
Mailing Address - Phone:907-262-6800
Mailing Address - Fax:907-262-9276
Practice Address - Street 1:203 W PIONEER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7527
Practice Address - Country:US
Practice Address - Phone:907-235-3225
Practice Address - Fax:907-235-3203
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-11-13
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Provider Licenses
StateLicense IDTaxonomies
AK3945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6688Medicaid
AKMD6688Medicaid
AKG34218Medicare UPIN