Provider Demographics
NPI:1811186844
Name:BOLAND, HOWARD (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:BOLAND
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 1:914 FM 517 W, 201B
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3923
Mailing Address - Country:US
Mailing Address - Phone:281-337-1350
Mailing Address - Fax:281-337-1350
Practice Address - Street 1:914 FM 517 W, 201B
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3923
Practice Address - Country:US
Practice Address - Phone:281-337-1350
Practice Address - Fax:281-337-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG31662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00B25COtherBLUE CROSS BLUE SHIELD
TX097476801Medicaid
E77002Medicare UPIN