| Doctor Name: | DR. SUZY T BOULES |
| NPI Number: | 1609042563 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D |
| License Number: | ME 92072 |
| Business Practice Address: | 232 N Orange Blossom Trl Orlando, FL - 328051612 |
| Business Phone Number: | 4074285751 |
| Business Fax Number: | 4074477245 |
| Mailing Address: | 232 N Orange Blossom Trl, ORLANDO |
| State: | FL |
| Postal Code: | 328051612 |
| Phone Number: | 4074285751 |
| Fax Number: | 4074477245 |
| NPI Enumeration Date: | 05/01/2008 |
| NPI Last Update Date: | 03/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 92072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |