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:
2120 S WAYSIDE DR
SUITE B
HOUSTON, TX
ZIP 77023

Phone Number: (713) 803-1840



Detailed Information

Sydney Lane Boule, M.D. is a student in an organized health care education/training program in Houston, 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:

2120 S WAYSIDE DR
SUITE B
HOUSTON, TX
ZIP 77023-900
Phone: (713) 803-1840
Fax: (713) 926-5852

The enumeration date for this NPI number is 4/28/2011 and was last updated on 8/11/2014.

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 2120 S WAYSIDE DR
12 Provider Second Line Business Practice Location Address SUITE B
13 Provider Business Practice Location Address City Name HOUSTON
14 Provider Business Practice Location Address State Name TX
15 Provider Business Practice Location Address Postal Code 770233900
16 Provider Business Practice Location Address Country Code If outside U S US
17 Provider Business Practice Location Address Telephone Number 7138031840
18 Provider Business Practice Location Address Fax Number 7139265852
19 Provider Enumeration Date 4/28/2011
20 Last Update Date 8/11/2014
21 Provider Gender Code F
22 Healthcare Provider Taxonomy Code 1 390200000X
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Is Sole Proprietor N

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This page was last updated on: 5/14/2012
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.