Provider Demographics
NPI:1073529665
Name:TOURSARKISSIAN, BOULOS (MD)
Entity Type:Individual
Prefix:DR
First Name:BOULOS
Middle Name:
Last Name:TOURSARKISSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NORTH MAIN, SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1204
Mailing Address - Country:US
Mailing Address - Phone:210-828-2503
Mailing Address - Fax:210-828-5731
Practice Address - Street 1:9153 HUEBNER RD.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1502
Practice Address - Country:US
Practice Address - Phone:210-614-7414
Practice Address - Fax:210-616-0509
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4591208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX770001947OtherMEDICARE RAIL ROAD
TX8FA758OtherBCBSTX - PVA
TX81549JOtherMEDICARE PIN FOR GROUP 00T148
TX117146403Medicaid
TXP01465883OtherMEDICARE RR - PVA
TX117146408Medicaid
TX80010SOtherBLUE CROSS BLUE SHIELD
TX117146402OtherCIDC
TXP01465883OtherMEDICARE RR - PVA
TX8L12279Medicare PIN