Provider Demographics
NPI:1295058550
Name:JOSEPH A BOULAY JR MD PA
Entity type:Organization
Organization Name:JOSEPH A BOULAY JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-410-6399
Mailing Address - Street 1:6198 52ND ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2405
Mailing Address - Country:US
Mailing Address - Phone:727-410-6399
Mailing Address - Fax:
Practice Address - Street 1:6198 52ND ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-2405
Practice Address - Country:US
Practice Address - Phone:727-410-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40296207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty