Individual
DR. RALEIGH J BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7 MEDICAL PARK, SUITE 104, COLUMBIA, SC 29223
(803) 434-3400
(803) 434-3938
Mailing address
PO BOX 2046, WEST COLUMBIA, SC 29171-2046
(803) 461-3000
(803) 461-4914
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
8500
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085008
—
SC
Enumeration date
11/10/2005
Last updated
10/04/2011
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