Brett Bolton, D,O

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

DO 1256 Issued in TN

Practice address

2715 E Oakland Park Blvd
Suite 200
Fort Lauderdale, FL 33306-1659

Phone

(954) 567-5868

Fax

(954) 567-5869

NPI assigned

May 19, 2010

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274227200000",
    "number": "1942529730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11664",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333391664",
            "telephone_number": "954-567-5868",
            "fax_number": "954-567-5869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 E OAKLAND PARK BLVD",
            "address_2": "SUITE 200",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061659",
            "telephone_number": "954-567-5868",
            "fax_number": "954-567-5869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLTON",
        "first_name": "BRETT",
        "name_prefix": "Dr.",
        "credential": "D,O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-19",
        "last_updated": "2010-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "0S0007493",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "DO 1256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bolanos-McMahan, LLC.
• Michael Bolanos, M.D.
• Oscar R Bolanos, D.D.S.
• Alicia Rena Bolden, PA-C
• Bolt RX LLC
• Kanthi Bommareddy, MD
• Ira Bond Jr., PT,DPT
• Leah Michelle Bonds, BCBA
• Norma Lorena Bonilla, APRN
• Gregory F Bonner, M.D

• General Practice Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.