Charles E Boult, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

M-13173 Issued in ID

Practice address

5966 W Curtisian Ave
Boise, ID 83706

Phone

(208) 302-5400

Fax

(208) 302-5455

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1962468025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-5400",
            "fax_number": "208-302-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5966 W CURTISIAN AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-302-5400",
            "fax_number": "208-302-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULT",
        "first_name": "CHARLES",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D57945",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "ID",
            "license": "M-13173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687003100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Calvin Botos, LPTA
• Shawna Denise Botos, PTA
• Julia K Bouchard, MD
• Wanda Burleson Bouchard, MA, LPC, NCC
• Emily Boudwin, NMT, LMT
• Cynthia M Boulton, NP
• Boundary Creek Counseling LLC
• William A Bourland, MD
• Brenda Lynn Bourn, RD
• Renee A. Bourquard, MD

• Geriatric Medicine (Internal Medicine) Physician in Boise, ID
• Providers in Boise, ID by specialty
• Geriatric Medicine (Internal Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.