Individual
DR. TONY BOUALOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12913 ARABIAN CT, PICKERINGTON, OH 43147-8112
(614) 753-6324
Mailing address
118 W COLUMBIA ST, FORT WAYNE, IN 46802-1725
(614) 753-6324
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
11022498A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2022
Last updated
03/28/2023
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