Healthcare Provider Details

I. General information

NPI: 1609830355
Provider Name (Legal Business Name): WILLIAM R BOULDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12499 UNIVERSITY AVE SUITE 210
DES MOINES IA
50325-8281
US

IV. Provider business mailing address

12499 UNIVERSITY AVE SUITE 210
DES MOINES IA
50325-8281
US

V. Phone/Fax

Practice location:
  • Phone: 515-440-2676
  • Fax: 515-440-2677
Mailing address:
  • Phone: 515-440-2676
  • Fax: 515-440-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19337
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: