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Individual
DOUGLAS A BOUDREAU
Active
Individual
DOUGLAS A BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
90555
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124669
BLUE CROSS BLUE SHIELD
—
01
—
1724934
FIRST HEALTH
—
01
—
204659403
MEDICAID
MO
05
—
204659403
—
MO
01
—
207515500
MEDICAID
MO
01
—
411755
HEALTHLINK
—
01
—
440546366
UNITED HEALTHCARE
—
01
—
7609055
AETNA
—
01
—
H00943
MERCY
—
01
—
PC10371
CIGNA
—
Enumeration date
04/20/2006
Last updated
09/20/2023
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