Basic Information
| Provider Information | |||||||||
| NPI: | 1639587173 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JASON M. BOLEY, MD., PLLC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 NORMAND DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797038848 | ||||||||
| FaxNumber: | 9797036485 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 NORMAND DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797038848 | ||||||||
| FaxNumber: | 9797036485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2014 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | BOLEY | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9797038848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | M0668 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.