Organization
DOCTOR BOU PEDIATRICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALVADOR ANGEL BOU-GAUTHIER (CEO / PHYSICIAN)
(813) 719-3716
Entity
Organization
Contact information
Practice address
1507 W REYNOLDS ST STE A, PLANT CITY, FL 33563-4702
(813) 719-3716
Mailing address
1507 W REYNOLDS ST STE A, PLANT CITY, FL 33563-4702
(813) 719-3716
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374065000
—
FL
Enumeration date
02/21/2008
Last updated
04/09/2018
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