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Contact Information

JONATHAN P BOLTAX, MD
555 E BROADWAY AVE STE 220
JACKSON, WY83001-8640
 Phone: 307-739-7305
 Fax: 307-739-4960
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for JONATHAN P BOLTAX · (Male)

NPI Number 1629023692
Status Active
Credentials MD
Entity Individual
Enumeration date 05/24/2006
Last updated 01/04/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • WY License # 9935A
  • WY Medicaid 121002500
Hospital affiliation(s)
  • UNIVERSITY HEALTH CARE/UNIV HOSPITALS AND CLINICS - (Acute Care)
    50 NORTH MEDICAL DRIVE
    SALT LAKE CITY, UT 84132
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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