Provider Demographics
NPI:1093520728
Name:BOLTZ, COREY ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ALEXANDER
Last Name:BOLTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:COREY
Other - Middle Name:ALEXANDER
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12834 FORT HANCOCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1881
Mailing Address - Country:US
Mailing Address - Phone:210-528-6548
Mailing Address - Fax:848-213-0591
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-528-6548
Practice Address - Fax:848-213-0591
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program