Organization
BOULWARE MEDICAL CLINIC L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J BOULWARE M.D. (DR.)
(816) 792-5577
Entity
Organization
Contact information
Practice address
1131 W KANSAS ST, LIBERTY, MO 64068-2281
(816) 792-5577
(816) 792-5141
Mailing address
1131 W KANSAS ST, LIBERTY, MO 64068-2281
(816) 792-5577
(816) 792-5141
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19532014
BLUE CROSS GROUP
MO
Enumeration date
06/01/2007
Last updated
07/27/2007
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