Jeffrey P. Bolduan, M.D. Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

01030767 Issued in IN

Legal business name

JEFFREY P. BOLDUAN, M.D. INC

Practice address

1615 Winsted Dr Ste 4
Goshen, IN 46526-4673

Phone

(574) 533-8420

Fax

(574) 533-3909

NPI assigned

Jun 23, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey P Bolduan, MD

Title

President

Phone

(574) 533-8420

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1538320577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 WINSTED DR STE 4",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264673",
            "telephone_number": "574-533-8420",
            "fax_number": "574-533-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 WINSTED DR STE 4",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264673",
            "telephone_number": "574-533-8420",
            "fax_number": "574-533-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY P. BOLDUAN, M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "BOLDUAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-533-8420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "IN",
            "license": "01030767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112510A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPO",
            "identifier": "1831278027",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in Goshen, IN
• Providers in Goshen, IN by specialty
• Urology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.