Frederick Thornton Boulware, M.D.
Individual provider Active NPI Neurology Physician · Phoenix, AZ
NPI 1497733174 · NPPES record last updated Sep 18, 2012
Key facts
- NPI
- 1497733174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 37701 (AZ)
- Practice address
- 2423 W Dunlap Ave
Ste 130
Phoenix, AZ 85021-5818 - Phone
- (602) 424-4450
- Fax
- (602) 424-4451
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100910000553 | AZ | Practitioner - Neurology |
5496847162 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37701 | AZ | MD | Clinical Neurophysiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amdx, LTD | Current |
Accepting new patients | |
| Neurodiagnostic Laboratories, LLC | Past | Accepting new patients | |
| Pinnacle Peak Neurology, LLC | Past | Accepting new patients | |
| United Hospitalist Inc. | Past | Accepting new patients |
Locations
10320 W McDowell Rd
Ste 6017
Avondale, AZ 85392
3011 S Lindsay Rd
Ste 113
Gilbert, AZ 85295
Phone (480) 377-4360
6136 E Brown Rd
Ste 103
Mesa, AZ 85205
1450 S Dobson Rd
Ste A305
Mesa, AZ 85202
Phone (480) 889-1993
2266 S Dobson Rd
Ste 105
Mesa, AZ 85202
2423 W Dunlap Ave
Phoenix, AZ 85021
Phone (602) 216-6862
2423 W Dunlap Ave
Ste 175
Phoenix, AZ 85021
Phone (480) 889-1993
2423 W Dunlap Ave
Ste 130
Phoenix, AZ 85021
Phone (480) 336-7400
10250 N 92nd St
Ste 304
Scottsdale, AZ 85258
Phone (480) 451-7676
12361 W Bola Dr
Ste 100
Surprise, AZ 85378
Phone (602) 698-7325
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 37701 | AZ | Yes |
| Clinical Neurophysiology Physician | 2084N0600X | 37701 | AZ | |
| Neuromuscular Medicine (Psychiatry & Neurology) Physician | 2084N0008X | 37701 | AZ |
Addresses
Primary practice location
2423 W Dunlap Ave
Ste 130
Phoenix, AZ 85021-5818
Mailing address
2423 W Dunlap Ave
Ste 130
Phoenix, AZ 85021-5818
Phone (602) 424-4450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002002038 | Medicaid | NV | |
| 100500484 | Medicaid | NV |
Other providers in Phoenix, AZ
- Tailyr Marnae Boudreaux
- Crystal Bouey
- Bougainvillea Manor LLC
- Michael Bougoulias
- Boukus Inc
- Paul Christopher Boulware
- Paige E Bouma
- Boundless Light, PLLC
- Anne Bourgeois
- Megan Bourgeois
All providers in Phoenix, AZ · Neurology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.