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Individual
MR. BRENT DAVID BOUDREAUX
Active
Individual
MR. BRENT DAVID BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.J00109
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069102490
BOC
—
01
—
ATH.J00109
LA STATE BOARD OF MEDICAL EXAMINERS
LA
Enumeration date
05/17/2007
Last updated
01/10/2021
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