Individual
JEFFREY N BOULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
730 W MARKET ST, LIMA, OH 45801-4602
(419) 227-3361
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35050653B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000317855
BCBS
OH
01
—
000000317855
BCBS
—
05
—
0561413
—
OH
Enumeration date
05/18/2006
Last updated
06/10/2013
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