Provider Demographics
NPI:1619921038
Name:BOLAND, CLEMENT RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:RICHARD
Last Name:BOLAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2214B ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2608
Mailing Address - Country:US
Mailing Address - Phone:214-740-1115
Mailing Address - Fax:214-818-9292
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:BAYLOR UNIVERSITY MEDICAL CENTER (H-250)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2096
Practice Address - Country:US
Practice Address - Phone:214-820-2650
Practice Address - Fax:214-818-9292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6798207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology