John A Boullier, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

R2K10 Issued in MO

Practice address

1155 W Parkview
Suite 2C
Bolivar, MO 65613-7800

Phone

(417) 326-2550

Fax

(417) 326-2552

NPI assigned

Sep 12, 2006

Last updated

Dec 29, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saint Louis Connectcare

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1396703278

  Urology

  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1841394459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133099",
            "telephone_number": "417-328-6501",
            "fax_number": "417-328-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 W PARKVIEW",
            "address_2": "SUITE 2C",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656137800",
            "telephone_number": "417-326-2550",
            "fax_number": "417-326-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULLIER",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "R2K10",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD",
            "identifier": "P00477605",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bolivar Physical Therapy Center, LLC
• Bolivar R-1 Schools
• Bolivar R0I
• Bolivar Smiles Dentistry, LLC
• Bolivar Vision, LLC (Vision Source Bolivar)
• Shawn R Brand
• Scott Brandhorst, PSYD
• Mark Darl Brecheisen Jr., D.O.
• Richard Lynn Brewer, PSY.D.
• Brian G Hackleman DC (Bolivar Family Chiropractic)

• Urology Physician in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Urology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; 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.