Organization
YANKTON UROLOGICAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH RAYMOND BOUDREAU MD (OWNER)
(605) 689-1100
Entity
Organization
Contact information
Practice address
2009 LOCUST ST, YANKTON, SD 57078-2030
(605) 689-1100
(605) 689-1104
Mailing address
2009 LOCUST ST, YANKTON, SD 57078-2030
(605) 689-1100
(605) 689-1104
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4016
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007559
BCBS
—
Enumeration date
09/13/2006
Last updated
01/04/2012
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