Organization
EAST TEXAS PODIATRY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT A BOUDREAU DPM (OWNER)
(903) 593-1749
Entity
Organization
Contact information
Practice address
1028 E IDEL, SUITE A, TYLER, TX 75701
(903) 593-1749
(903) 593-1487
Mailing address
1028 E IDEL, SUITE A, TYLER, TX 75701
(903) 593-1749
(903) 593-1487
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480028507
RAILROAD MEDICARE
TX
01
—
5594780001
PALMETTO DME
TX
Enumeration date
09/21/2006
Last updated
03/03/2009
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