| Jason Henry Boulter, MD | |
| 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | |
| (210) 916-7500 | |
| Not Available | 
| Full Name | Jason Henry Boulter | 
|---|---|
| Gender | Male | 
| Speciality | Neurological Surgery | 
| Location | 3551 Roger Brooke Dr, Fort Sam Houston, Texas | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1336672914 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207T00000X | Neurological Surgery | V8212 (Texas) | Primary | 
| Entity Name | Piedmont Providers Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1548273592 PECOS PAC ID: 9830082825 Enrollment ID: O20040204000321 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jason Henry Boulter, MD 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 Ph: () - | Jason Henry Boulter, MD 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 Ph: (210) 916-7500 | 
| Dr. Jason Robert Hall, M.D. Neurological Surgery Medicare: Accepting Medicare Assignments Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-539-9582 | |
| Dr. Kenneth D Sack, M.D. Neurological Surgery Medicare: Medicare Enrolled Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-539-9582 | |
| Dr. Ryan Mcdermott, MD Neurological Surgery Medicare: Medicare Enrolled Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-539-9582 | |
| Dr. Ian S. Mcdougall, M.D. Neurological Surgery Medicare: Accepting Medicare Assignments Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-539-9582 | |
| Geoffrey William Peitz, MD Neurological Surgery Medicare: Medicare Enrolled Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-916-3482 | |
| Victor Sabourin,  Neurological Surgery Medicare: Medicare Enrolled Practice Location: 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234 Phone: 210-539-9582 |