Individual
DOUGLAS A BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
303 FRASER DR, HINESVILLE, GA 31313-3712
(912) 877-2227
(912) 877-2332
Mailing address
PO BOX 1520, HINESVILLE, GA 31310-8520
(912) 318-3947
(912) 587-7018
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
90555
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124669
BLUE CROSS BLUE SHIELD
—
01
—
1724934
FIRST HEALTH
—
01
—
204659403
MEDICAID
MO
05
—
204659403
—
MO
01
—
207515500
MEDICAID
MO
01
—
411755
HEALTHLINK
—
01
—
440546366
UNITED HEALTHCARE
—
01
—
7609055
AETNA
—
01
—
H00943
MERCY
—
01
—
PC10371
CIGNA
—
Enumeration date
04/20/2006
Last updated
09/20/2023
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