Basic Information
| Provider Information | |||||||||
| NPI: | 1558339374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4730 N HABANA AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336147148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135492134 | ||||||||
| FaxNumber: | 8138644436 | ||||||||
| Practice Location | |||||||||
| Address1: | 7207 GOLDEN WINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322443324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043891010 | ||||||||
| FaxNumber: | 9043891082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME91494 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | ME91494 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | ME91494 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | ME91494 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.