| Doctor Name: | JEFFERSON L BOULET |
| NPI Number: | 1740274745 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | PA10003567 |
| Business Practice Address: | 305 N River Ave Buckley, WA - 983218978 |
| Business Phone Number: | 3608290625 |
| Business Fax Number: | 3608299860 |
| Mailing Address: | Po Box 1268, BUCKLEY |
| State: | WA |
| Postal Code: | 983211268 |
| Phone Number: | 3608290625 |
| Fax Number: | 3608299860 |
| NPI Enumeration Date: | 09/06/2005 |
| NPI Last Update Date: | 03/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA10003567 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |