Provider Demographics
NPI:1013914357
Name:BOLGER, JOSEPH E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:BOLGER
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 1:101 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055
Mailing Address - Country:US
Mailing Address - Phone:318-377-7118
Mailing Address - Fax:318-377-7392
Practice Address - Street 1:101 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055
Practice Address - Country:US
Practice Address - Phone:318-377-7118
Practice Address - Fax:318-377-7392
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14517R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1052825Medicaid
H81455Medicare UPIN
LA1052825Medicaid