Provider Demographics
NPI:1922254648
Name:BOLDEN, PAUL LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LEE
Last Name:BOLDEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:BIXLER EMERGENCY CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-0756
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:BIXLER EMERGENCY CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-0756
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant