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General NPI Number Information
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NPI Number | 1174502827
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Entity Type | Individual
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Provider Name | MOLLY B BOULDIN MD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 521 MONTGOMERY HWY SUITE 117
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City | BIRMINGHAM
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State | AL
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Zip | 35216-1878
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Country | US
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Telephone | 205-824-4441
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Fax | 205-822-3978
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Provider Business Mailing Address
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Address Line | 521 MONTGOMERY HWY SUITE 117
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City | BIRMINGHAM
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State | AL
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Zip | 35216-1878
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Country | US
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Telephone | 205-824-4441
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Fax | 205-822-3978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 00025634
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License Number State | AL
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