Individual
DR. EDMUND C.A. BOULTING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
785 PRIMERA BLVD, SUITE 1031, LAKE MARY, FL 32746-2124
(407) 834-8111
(407) 708-1958
Mailing address
785 PRIMERA BLVD, SUITE 1031, LAKE MARY, FL 32746-2124
(407) 834-8111
(407) 708-1958
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME70127
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379728700
—
FL
Enumeration date
02/22/2007
Last updated
06/25/2024
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