Individual
DR. ROBERT J BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1131 W KANSAS ST, LIBERTY, MO 64068-2281
(816) 792-5577
Mailing address
1131 W KANSAS ST, LIBERTY, MO 64068-2281
(816) 792-5577
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R6P08
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203723408
—
MO
Enumeration date
10/19/2006
Last updated
07/17/2013
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