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NPI Code Detail

MEDICARE: DR. JAMES W BOALS SR. MD

MEDICARE: DR. JAMES W BOALS SR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician6979TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104829845
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES W BOALS SR. MD
Provider Business Mailing Address
First Line : 8010 STAGE HILLS BLVD
Second Line :
City : BARTLETT
State : TN
Zip : 38133-4032
Country : US
Telephone Number : 901-291-2400
Fax Number :
Provider Business Practice Location Address
First Line : 1265 UNION AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-3415
Country : US
Telephone Number : 901-726-7358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2005
Last Update Date : 12/28/2007

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