Provider Demographics
NPI:1336297365
Name:BOLOURIAN, REZA (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:BOLOURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10260 SAWMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9189
Mailing Address - Country:US
Mailing Address - Phone:614-766-7777
Mailing Address - Fax:614-766-7779
Practice Address - Street 1:10260 SAWMILL PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9189
Practice Address - Country:US
Practice Address - Phone:614-766-7777
Practice Address - Fax:614-766-7779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89591207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck