Individual
FREDERICK THORNTON BOULWARE
Active
Individual
FREDERICK THORNTON BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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