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General NPI Number Information
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NPI Number | 1609830355
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Entity Type | Individual
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Provider Name | WILLIAM R BOULDEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 12499 UNIVERSITY AVE SUITE 210
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City | DES MOINES
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State | IA
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Zip | 50325-8281
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Country | US
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Telephone | 515-440-2676
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Fax | 515-440-2677
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Provider Business Mailing Address
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Address Line | 12499 UNIVERSITY AVE SUITE 210
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City | DES MOINES
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State | IA
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Zip | 50325-8281
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Country | US
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Telephone | 515-440-2676
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Fax | 515-440-2677
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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 | 19337
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License Number State | IA
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