Individual
TYLER GERARD BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7777 HENNESSY BLVD STE 7000, BATON ROUGE, LA 70808-0307
(225) 765-8829
(225) 765-8283
Mailing address
13505 N AMISS RD, BATON ROUGE, LA 70810-5038
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
322678
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
322678
STATE LICENSE
LA
Enumeration date
03/19/2018
Last updated
08/04/2021
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