Provider Demographics
NPI:1467455642
Name:BOULDEN, THOMAS F (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:BOULDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N DUNLAP ST
Mailing Address - Street 2:GROUND FLOOR - RADIOLOGY
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2800
Mailing Address - Country:US
Mailing Address - Phone:901-572-3041
Mailing Address - Fax:
Practice Address - Street 1:50 N DUNLAP ST
Practice Address - Street 2:GROUND FLOOR - RADIOLOGY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2800
Practice Address - Country:US
Practice Address - Phone:901-572-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN156762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3035120Medicare ID - Type Unspecified
TNA99850Medicare UPIN