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General NPI Number Information
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NPI Number | 1619921038
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Entity Type | Individual
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Provider Name | CLEMENT RICHARD BOLAND JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3500 GASTON AVE BAYLOR UNIVERSITY MEDICAL CENTER (H-250)
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City | DALLAS
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State | TX
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Zip | 75246-2096
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Country | US
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Telephone | 214-820-2650
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Fax | 214-818-9292
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Provider Business Mailing Address
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Address Line | 2214B ALLEN ST
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City | DALLAS
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State | TX
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Zip | 75204-2608
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Country | US
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Telephone | 214-740-1115
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Fax | 214-818-9292
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | L6798
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License Number State | TX
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