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Contact Information

ALEX R BOLLER, PA-C
301 HIWASSEE COMMUNITY DR.
MADISONVILLE, TN37354
 Phone: 423-436-7730
 Fax: 423-436-0384
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for ALEX R BOLLER · (Male)

NPI # 1568449205
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 12/23/2005
Last updated 03/07/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 004090
  • PA License # MA-001385-L
  • TN License # 4902
  • Other 910248 NCCPA #
  • NY Other 004090 LICENSE
  • PA Other MA-001385-L LICENSE
Hospital affiliation(s) Not Available
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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