Active NPI
Paul Lee Bolden, PA
- Physician Assistant
- Tallahassee, FL
National Provider Identifier
1922254648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9102041
- Practice address
- 1300 Miccosukee Rd
Bixler Emergency Center
Tallahassee, FL 32308-5054 - Phone
- (850) 431-0756
- Fax
- (850) 431-0779
- NPI assigned
- Aug 13, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9102041 | FL | Primary |
Addresses
Primary practice location
1300 Miccosukee Rd
Bixler Emergency Center
Tallahassee, FL 32308-5054
Mailing address
1300 Miccosukee Rd
Bixler Emergency Center
Tallahassee, FL 32308-5054
Phone (850) 431-0756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9102041 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218585600000",
"number": "1922254648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 MICCOSUKEE RD",
"address_2": "BIXLER EMERGENCY CENTER",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323085054",
"telephone_number": "850-431-0756",
"fax_number": "850-431-0779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 MICCOSUKEE RD",
"address_2": "BIXLER EMERGENCY CENTER",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323085054",
"telephone_number": "850-431-0756",
"fax_number": "850-431-0779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDEN",
"first_name": "PAUL",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-13",
"last_updated": "2008-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9102041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.