Larry Edward Bolton Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 02475 Issued in TX

Practice address

3000 S Ih 35
Ste 205
Austin, TX 78704-6513

Phone

(512) 912-8200

Fax

(512) 912-8206

NPI assigned

Jun 26, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The University of Texas Health Science Center at San Antonio

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1326829904
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214438400000",
    "number": "1164684692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 S IH 35",
            "address_2": "STE 205",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787046513",
            "telephone_number": "512-912-8200",
            "fax_number": "512-912-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 S IH 35",
            "address_2": "STE 205",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787046513",
            "telephone_number": "512-912-8200",
            "fax_number": "512-912-8206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "LARRY",
        "middle_name": "EDWARD",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2008-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA 02475",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA 02475",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brennan Bollmer
• Heidi A Bollock, CNS
• Tom N Bolls, LPC
• Alena Bolshakova, PTA
• Kim P Bolton, MD
• Ross Matthew Bomben, D.C.
• Jennifer Bommer, LPC-I
• Nicole Bonar, CRNP
• Franklin S Bonasso, DDS
• Bonaterra Inc.

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.