Individual
FREDERICK THORNTON BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2423 W DUNLAP AVE, STE 130, PHOENIX, AZ 85021-5818
(602) 424-4450
(602) 424-4451
Mailing address
2423 W DUNLAP AVE, STE 130, PHOENIX, AZ 85021-5818
(602) 424-4450
(602) 424-4451
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
37701
AZ
2084N0400X
Neurology Physician
Primary
37701
AZ
2084N0600X
Clinical Neurophysiology Physician
37701
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002002038
—
NV
05
—
100500484
—
NV
Enumeration date
01/04/2006
Last updated
09/18/2012
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