Molly B Bouldin, MD

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

00025634 Issued in AL

Practice address

521 Montgomery Hwy
Suite 117
Birmingham, AL 35216-1878

Phone

(205) 824-4441

Fax

(205) 822-3978

NPI assigned

Jan 11, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aqua Dermatology of Alabama PC

  • MOHS-Micrographic Surgery Physician
  • Vestavia HLS, AL
  • NPI 1477708642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174502827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 MONTGOMERY HWY",
            "address_2": "SUITE 117",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352161878",
            "telephone_number": "205-824-4441",
            "fax_number": "205-822-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 MONTGOMERY HWY",
            "address_2": "SUITE 117",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352161878",
            "telephone_number": "205-824-4441",
            "fax_number": "205-822-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "MOLLY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "AL",
            "license": "00025634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Sloan Boudreau, DMD
• Hunter Boudreau
• Sellers Boudreau
• Arthur Boudreaux
• Lauren Boudreaux
• Christina Michelle Boulineaux
• Megan Boullion, DNP, FNP-BC
• Julia Boullt, MD
• Georges Bouobda Tsemo, MD
• Andre Bourg, MD

• Dermatopathology Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Dermatopathology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.