Individual provider · NPI-1

Bryon Boulton, MD

Thoracic Surgery (Cardiothoracic Vascular Surgery) · Raleigh, NC

NPI number1497966782
StatusActive
Last updated in NPPESFeb 16, 2021

Details

NPI
1497966782
Entity type
Individual (NPI-1)
Name
Bryon Boulton
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
May 25, 2007
Certification date
Feb 16, 2021
Last updated
Feb 16, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery)2012-01328NCYes

Practice location

3000 New Bern Ave
Raleigh, NC 27610-1231

Phone 919-350-7600

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010

Phone 877-498-4490

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