Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2017018434 | MO |
NPI | 1003337858 |
---|---|
Provider Name | Dr. William Kells Boland |
First Address | Saint Louis, MO 63110 |
Second Address | St. Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2017 |
Last Update Date | 02/07/2017 |