Provider Demographics
NPI:1780095737
Name:BOULOS, PAUL ADLY (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ADLY
Last Name:BOULOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 SW 124TH AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4634
Mailing Address - Country:US
Mailing Address - Phone:305-262-8347
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE STE 317
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4634
Practice Address - Country:US
Practice Address - Phone:305-264-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program