Individual
DR. LON A BOUTIETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 863-7607
(205) 437-5998
Mailing address
PO BOX 88452, CHICAGO, IL 60680-1452
(205) 437-6098
(205) 437-5998
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME51154
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04698
BCBS PROVIDER NUMBER
FL
01
—
059184932
BCBS PROVIDER NUMBER
AL
01
—
059184933
BCBS PROVIDER NUMBER
AL
01
—
059184934
BCBS PROVIDER NUMBER
AL
05
—
063236800
—
FL
Enumeration date
05/12/2006
Last updated
05/13/2009
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