Provider Demographics
NPI:1700039112
Name:BOATMAN, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BOATMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:320 E SOUTHMORE AVE
Mailing Address - Street 2:#324-A
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1136
Mailing Address - Country:US
Mailing Address - Phone:713-534-0407
Mailing Address - Fax:713-534-0813
Practice Address - Street 1:320 E SOUTHMORE AVE
Practice Address - Street 2:#324-A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1136
Practice Address - Country:US
Practice Address - Phone:713-534-0407
Practice Address - Fax:713-534-0813
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80262237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist