Provider Demographics
NPI:1174502827
Name:BOULDIN, MOLLY B (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:B
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:521 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1878
Mailing Address - Country:US
Mailing Address - Phone:205-824-4441
Mailing Address - Fax:205-822-3978
Practice Address - Street 1:521 MONTGOMERY HWY
Practice Address - Street 2:SUITE 117
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1878
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:205-822-3978
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00025634207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG99565Medicare UPIN