Active NPI
Robert Deane Bolton, M.D.
- Pediatrics Physician
- Fairchild Afb, WA
National Provider Identifier
1063738631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD2013-0296
- Practice address
- 701 Hospital Loop
Fairchild Afb, WA 99011-8704 - Phone
- (509) 247-9043
- NPI assigned
- Apr 7, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1063738631 | IN | |
| Pediatrics Physician | 208000000X | MD2013-0296 | NM | Primary |
Addresses
Primary practice location
701 Hospital Loop
Fairchild Afb, WA 99011-8704
Mailing address
Landstuhl Regional Medical Center Unit 33100
Apo, AE 09180-3100
Phone (314) 590-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240104003852 | WA | Order and Referring Only - Pediatric Medicine | 9830328178 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1063738631 | IN | MD | Pediatrics Physician |
| MD2013-0296 | NM | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1063738631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100",
"city": "APO",
"state": "AE",
"postal_code": "091803100",
"telephone_number": "314-590-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 HOSPITAL LOOP",
"city": "FAIRCHILD AFB",
"state": "WA",
"postal_code": "990118704",
"telephone_number": "509-247-9043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTON",
"first_name": "ROBERT",
"middle_name": "DEANE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-07",
"last_updated": "2023-08-11",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "1063738631",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "MD2013-0296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairchild Afb, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.