Provider Demographics
NPI:1609087519
Name:BOULDIN, CAROLE-ANNE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE-ANNE
Middle Name:
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WESTERN BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6059
Mailing Address - Country:US
Mailing Address - Phone:214-914-4712
Mailing Address - Fax:
Practice Address - Street 1:101 WESTERN BREEZE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-6059
Practice Address - Country:US
Practice Address - Phone:214-914-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9874207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0022610OtherINSTITUTIONAL PERMIT