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Organization
SUSAN L. BOULLIOUN, M.D., P.A.
Active
Organization
SUSAN L. BOULLIOUN, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN LORTON BOULLIOUN M.D. (PRESIDENT)
(830) 303-3500
Entity
Organization
Contact information
Practice address
113 E. CEDAR ST., SEGUIN, TX 78155-3709
(830) 303-3500
(830) 303-9399
Mailing address
113 E CEDAR ST, SEGUIN, TX 78155-3709
(830) 303-3500
(830) 303-9399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K2312
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121420702
—
TX
05
—
121420704
—
TX
Enumeration date
01/12/2009
Last updated
01/07/2010
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