Individual
DR. JOHN PHILIP BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W ESPLANADE AVE, SUITE 200, KENNER, LA 70065-2489
(504) 464-8500
(504) 464-8525
Mailing address
200 W ESPLANADE AVE, SUITE 200, KENNER, LA 70065-2489
(504) 464-8500
(504) 646-8525
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
014711
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932965
—
AL
05
—
08658853
—
MS
05
—
1337561
—
LA
Enumeration date
07/25/2006
Last updated
01/15/2010
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