Provider Demographics
NPI:1316232382
Name:BOULDIN, ERIC B (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:BOULDIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 N SPRING ST
Mailing Address - Street 2:MANCHESTER
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1563
Mailing Address - Country:US
Mailing Address - Phone:931-728-3988
Mailing Address - Fax:931-728-6530
Practice Address - Street 1:108 N SPRING ST
Practice Address - Street 2:MANCHESTER
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1563
Practice Address - Country:US
Practice Address - Phone:931-728-3988
Practice Address - Fax:931-728-6530
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN713213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery