Individual
DR. JASON BASHIR BOUDJOUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 COMMERCE DR, WARWICK, RI 02886-2430
(401) 921-5970
(401) 921-5973
Mailing address
1 ASHLEY DR, LINCOLN, RI 02865-1434
(401) 334-3754
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD12133
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396864542
NPI KENT HOSPITAL PBO
RI
Enumeration date
06/19/2006
Last updated
08/12/2021
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