Provider Demographics
NPI:1184608218
Name:BOULWARE, FLETCHER MAURICE JR (MD)
Entity type:Individual
Prefix:DR
First Name:FLETCHER
Middle Name:MAURICE
Last Name:BOULWARE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6600 VAN AALST BLVD
Mailing Address - Street 2:ANESTHESIA SUITE 2ND FLOOR
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:762-408-3108
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:ANESTHESIA SUITE 2ND FLOOR
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:762-408-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00026348207L00000X
GA066259207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology