Doctor Name: | MARCUS A BOUDREAUX |
NPI Number: | 1235255712 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | 079290APO4239 |
Business Practice Address: | 600 Cypress St Sulphur, LA - 706635052 |
Business Phone Number: | 3375276371 |
Business Fax Number: | 3375282034 |
Mailing Address: | 600 Cypress St, SULPHUR |
State: | LA |
Postal Code: | 706635052 |
Phone Number: | 3375276371 |
Fax Number: | 3375282034 |
NPI Enumeration Date: | 03/22/2007 |
NPI Last Update Date: | 06/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 079290APO4239 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |