Provider Demographics
NPI:1972573590
Name:BOULAS, H. JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:H.
Middle Name:JAY
Last Name:BOULAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:STE 514
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-345-4595
Mailing Address - Fax:214-345-4596
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:STE 514
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-345-4595
Practice Address - Fax:214-345-4596
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8014207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022AMOtherBLUE CROSS BLUE SHIELD
5067730001OtherMEDICARE LEGACY
5067730001OtherMEDICARE LEGACY
TX00420TMedicare PIN
TX0022AMOtherBLUE CROSS BLUE SHIELD