# EBONY BEAUDOIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1124053095
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | M2203 | TX | Yes |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | M2203 | TX | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 05/04/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 176422501 | — | TX |
| 05 | — | 190090401 | — | TX |
| 01 | — | 8U5760 | BCBS | TX |