Larry Edward Bolton JR., PA-C

NPI #1164684692 in Austin, Texas

Provider Information

NPI Number: 1164684692
Entity Type: Individual
Name: Larry Edward Bolton JR., PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jun 26, 2008
Last Updated: Jun 26, 2008

Practice Location

Address: 3000 S IH 35
Address 2: STE 205
City: Austin
State: Texas
ZIP Code: 78704-6513
Phone: (512) 912-8200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary
Physician Assistant - Surgical — Surgical	363AS0400X

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