# DR. SUSAN L BOULLIOUN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1528148889
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | K2312 | TX | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 06/10/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121420704 | — | TX |
| 05 | — | 121420705 | — | TX |
| 05 | — | 205495901 | — | TX |