NPIMap

Organization Active NPI

Edgar B Bolton DO PA

  • Pulmonary Disease Physician
  • Fort Lauderdale, FL
National Provider Identifier
1790122778
Registry record updated Nov 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
OS 2458 Issued in FL
Legal business name
EDGAR B BOLTON DO PA
Practice address
1512 SE 10TH St
Fort Lauderdale, FL 33316-1420
Phone
(954) 445-1754
Fax
(954) 766-8199
NPI assigned
May 30, 2013
Last updated
Nov 6, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2013

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

Authorized official

Name
Dr. Edgar B Bolton Jr., DONPI 1487635462
Title
President
Phone
(954) 445-1754

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X OS 2458 FL Primary

Addresses

Primary practice location

1512 SE 10TH St
Fort Lauderdale, FL 33316-1420

Mailing address

1512 SE 10TH St
Fort Lauderdale, FL 33316-1420
Phone (954) 445-1754

Other identifiers 1

IdentifierTypeStateIssuer
037708200MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383696000000",
    "number": "1790122778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 SE 10TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161420",
            "telephone_number": "954-445-1754",
            "fax_number": "954-766-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 SE 10TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161420",
            "telephone_number": "954-445-1754",
            "fax_number": "954-766-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGAR B BOLTON DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-11-06",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-445-1754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "OS 2458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037708200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; 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.