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General NPI Number Information
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NPI Number | 1306338397
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Entity Type | Individual
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Provider Name | ALEXANDRE REGINALD BOULOS MD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 3440 HOLLYWOOD BLVD STE 140
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6900
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Country | US
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Telephone | 954-276-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 CORPORATE WAY DOOR D
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City | MIRAMAR
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State | FL
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Zip | 33025-3925
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Country | US
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Telephone | 954-275-5501
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A194916
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD19055
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License Number State | RI
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