SYDNEY LANE BOULE, M.D. - NPI NUMBER 1730470451

Summary

Provider Name: SYDNEY LANE BOULE, M.D.

NPI Number: 1730470451

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Address:
605 S. CONROE MEDICAL DRIVE
CONROE, TX
ZIP 77304

Phone Number: (936) 539-4004



Detailed Information

Sydney Lane Boule, M.D. is a student in an organized health care education/training program in Conroe, TX. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1730470451 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

605 S. CONROE MEDICAL DRIVE
CONROE, TX
ZIP 77304-722
Phone: (936) 539-4004
Fax: (936) 539-3635

The enumeration date for this NPI number is 4/28/2011 and was last updated on 8/1/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program Yes

NPI Record

No. Field Name Field Value
1 NPI 1730470451
2 Entity Type Code 1
3 Provider Last Name Legal Name BOULE
4 Provider First Name SYDNEY
5 Provider Middle Name LANE
6 Provider Credential Text M.D.
7 Provider Other Last Name VONK
8 Provider Other First Name SYDNEY
9 Provider Other Middle Name LANE
10 Provider Other Last Name Type Code 1
11 Provider First Line Business Practice Location Address 605 S. CONROE MEDICAL DRIVE
12 Provider Business Practice Location Address City Name CONROE
13 Provider Business Practice Location Address State Name TX
14 Provider Business Practice Location Address Postal Code 773044722
15 Provider Business Practice Location Address Country Code If outside U S US
16 Provider Business Practice Location Address Telephone Number 9365394004
17 Provider Business Practice Location Address Fax Number 9365393635
18 Provider Enumeration Date 4/28/2011
19 Last Update Date 8/1/2012
20 Provider Gender Code F
21 Healthcare Provider Taxonomy Code 1 390200000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Sole Proprietor N

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.