Individual
JOHN A BOULLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1155 W PARKVIEW, SUITE 2C, BOLIVAR, MO 65613-7800
(417) 326-2550
(417) 326-2552
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3099
(417) 328-6501
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R2K10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00477605
PALMETTO GBA RAILROAD
MO
Enumeration date
09/12/2006
Last updated
12/29/2016
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