Provider Demographics
NPI:1053399881
Name:BOULET, JOHN E (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BOULET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2128
Mailing Address - Fax:520-838-2260
Practice Address - Street 1:1714 W ANKLAM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2689
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ12754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248931Medicaid
AZZ20476Medicare PIN
AZZ20474Medicare PIN
AZ248931Medicaid
D36580Medicare UPIN