JERRY MICHAEL BOLDUAN MD
NPI 1396043758
General Practice in Sebastopol, CA

Q: What is Jerry Bolduan's NPI number?

The NPI number for Jerry Bolduan is 1396043758. It was assigned to this individual provider in the NPPES registry on March 9, 2011.

Q: What is Jerry Bolduan's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Bolduan was last updated on March 9, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 09, 2011

10450 CHERRY RIDGE RD, SEBASTOPOL, CA 95472(707) 823-5583 Get Directions Write a Review

NPPES record last updated: March 9, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jerry Michael Bolduan Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRY MICHAEL BOLDUAN MD (NPI 1396043758) is an individual general practice provider in Sebastopol, California, licensed in California (G032312) and active in the NPI registry since March 2011.

NPPES Registry Identity

NPI1396043758

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameJERRY MICHAEL BOLDUANCredential: MD

Location Address10450 CHERRY RIDGE RDSebastopol, CA 95472-9028

Mailing Address10450 Cherry Ridge RdSebastopol, CA 95472-9028 · (707) 823-5583

Phone(707) 823-5583

Sole ProprietorYes

Enumeration DateMarch 9, 2011

✔ NPI 1396043758 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in CA · G032312

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

10450 CHERRY RIDGE RD, Sebastopol, CA 95472

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Bolduan's NPI number?

The NPI number for Jerry Bolduan is 1396043758. It was assigned to this individual provider in the NPPES registry on March 9, 2011.

Where is Jerry Bolduan located?

Jerry Bolduan practices at 10450 Cherry Ridge Rd, Sebastopol, CA 95472. The listed phone number is (707) 823-5583.

What is Jerry Bolduan's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Jerry Bolduan was last updated on March 9, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.