Individual
CHARLES E BOULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5966 W CURTISIAN AVE, BOISE, ID 83706
(208) 302-5400
(208) 302-5455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5400
(208) 302-5455
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
D57945
MD
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
M-13173
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687003100
—
MD
Enumeration date
04/26/2006
Last updated
05/23/2016
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