J. Blake Bolin, M.D., P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

K8014 Issued in TX

Legal business name

J. BLAKE BOLIN, M.D., P.A.

Practice address

3550 Parkwood Blvd
Ste 405
Frisco, TX 75034-1903

Phone

(469) 287-8800

Fax

(469) 287-8801

NPI assigned

Jan 6, 2008

Organization subpart

Yes

Parent organization

J. BLAKE BOLIN, M.D.As reported in NPPES

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

Authorized official

Name

Donna K Ward, CPC

Title

Billing Rep

Phone

(214) 551-5101

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• J. Blake Bolin, M.D. Other name

Locations

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

{
    "created_epoch": "1199577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199577600000",
    "number": "1285819516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 PARKWOOD BLVD",
            "address_2": "STE 405",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750341903",
            "telephone_number": "469-287-8800",
            "fax_number": "469-287-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 PARKWOOD BLVD",
            "address_2": "STE 405",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750341903",
            "telephone_number": "469-287-8800",
            "fax_number": "469-287-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. BLAKE BOLIN, M.D., P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "J. BLAKE BOLIN, M.D.",
        "enumeration_date": "2008-01-06",
        "last_updated": "2008-01-06",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BILLING REP",
        "authorized_official_telephone_number": "214-551-5101",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "K8014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1174563043",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "J. Blake Bolin, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Specialist in Frisco, TX
• Providers in Frisco, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.