Bouldin, John William
Bouldin, John William is an individual health care provider with primary practice located at 1802 Braeburn Dr , Salem VA 24153-7357. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Bouldin, John William can be contacted via phone (540) 772-3580.Contact Information
Primary practice address
1802 Braeburn Dr
Salem VA 24153-7357
Phone: (540) 772-3580
Fax: (540) 725-5012
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 0101055716 | Virginia |
Profile Details
| NPI number | 1386624930 |
|---|---|
| LBN Legal business name | Bouldin, John William |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 19th, 2006 |
| Last updated | May 2nd, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386624930 | NPPES |
| Virginia | MEDICAID | 6701302 | |
| Virginia | Other | 281202 | |
| Virginia | MEDICAID | 1386624930 |
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