Individual
CHAD ANTHONY BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1102 W 32ND ST., JOPLIN, MO 64804
(417) 347-1111
Mailing address
1102 W 32ND ST., JOPLIN, MO 64804
(417) 347-1111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2004030781
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100710630J
—
OK
05
—
200303960A
—
KS
Enumeration date
08/23/2006
Last updated
10/30/2023
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