Provider Demographics
NPI:1457522468
Name:H. JAY BOULAS, M.D., P.A.
Entity Type:Organization
Organization Name:H. JAY BOULAS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-345-4595
Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022AMOtherBLUE CROSS BLUE SHIELD TX
TX0022AMOtherBLUE CROSS BLUE SHIELD TX
TX5067730001Medicare NSC
TXE13621Medicare UPIN