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General NPI Number Information
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NPI Number | 1386389013
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Entity Type | Individual
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Provider Name | PETER BOULES DO
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Gender | Male
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 3425 EXECUTIVE PKWY STE 100
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City | TOLEDO
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State | OH
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Zip | 43606-1326
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Country | US
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Telephone | 419-472-1124
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Fax | 419-486-8857
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Provider Business Mailing Address
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Address Line | 3425 EXECUTIVE PKWY STE 100
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City | TOLEDO
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State | OH
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Zip | 43606-1326
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5151015526
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.018158
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License Number State | OH
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