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Individual

MARK RICARD BOUDREAU JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
304 SHORTER AVE NW STE 105, ROME, GA 30165-4256
(706) 236-4880
Mailing address
420 E 2ND AVE STE 103, ROME, GA 30161-3210
(706) 509-3000

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11273
GA

Other

Enumeration date
04/10/2019
Last updated
05/26/2023
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