Individual
BRIAN LOUIS BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300 LONGWOOD AVE, DEPARTMENT OF OTOLARYNGOLOGY, BOSTON, MA 02115-5724
(617) 355-6460
Mailing address
300 LONGWOOD AVE, DEPARTMENT OF OTOLARYNGOLOGY, BOSTON, MA 02115-5724
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA5161
MA
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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