MR. ANTHONY BRADLEY BOLAND M.D. NPI 1437135373

NPI Information

NPI: 1437135373
Provider Name: MR. ANTHONY BRADLEY BOLAND, M.D.
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 984-2680
Get Directions

MR. Anthony Bradley Boland, M.D. is a vascular surgery surgery in Jackson, MS. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. MR. Anthony Bradley Boland, M.D. NPI is 1437135373. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 984-2680
Fax: (601) 815-4563

The enumeration date for this NPI number is 12/22/2005 and was last updated on 12/3/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	MD29549	TENNESSEE	No
2	2086S0129X	Surgery	Vascular Surgery	044417	GEORGIA	No
3	2086S0129X	Surgery	Vascular Surgery	MD00022869	WASHINGTON	No
4	2086S0129X	Surgery	Vascular Surgery	20979	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100033107	OTHER	TENNESSEE	PHP TENNCARE
2	4078780	OTHER		AETNA
3	P01189946	OTHER	MISSISSIPPI	RAILROAD MEDICARE PTAN
4	77BBBJT	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA
5	00832917B	MEDICAID	GEORGIA
6	G8867601	MEDICARE PIN	WASHINGTON
7	62178953301	OTHER	TENNESSEE	JOHN DEERE HEALTHCARE
8	8490567	MEDICAID	WASHINGTON
9	302I775602	MEDICARE PIN	MISSISSIPPI
10	56812	OTHER		FIRST HEALTH
11	3812941	MEDICARE ID-TYPE UNSPECIFIED	TENNESSEE
12	3812941	MEDICAID	TENNESSEE
13	0140040322	OTHER	TENNESSEE	CIGNA HMO
14	3153656	OTHER	TENNESSEE	BLUECROSS OF TN
15	375421YWZ1	MEDICARE PIN	MISSISSIPPI
16	3740047	OTHER	TENNESSEE	UNITED HEALTHCARE
17	A04109	MEDICARE UPIN	TENNESSEE
18	330005116	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	RAILROAD
19	009965915	MEDICAID	ALABAMA
20	07188733	MEDICAID	MISSISSIPPI
21	302I773113	MEDICARE PIN	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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