Individual
CAROLE-ANNE BOULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 WESTERN BREEZE DR, FORT WORTH, TX 76126-6059
(214) 914-4712
Mailing address
101 WESTERN BREEZE DR, FORT WORTH, TX 76126-6059
(214) 914-4712
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M9874
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP1-0022610
INSTITUTIONAL PERMIT
—
Enumeration date
05/24/2007
Last updated
03/27/2018
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