Organization
JACQUELINE BOUTROUILLE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE D BOUTROUILLE MD (OWNER)
(954) 340-3000
Entity
Organization
Contact information
Practice address
7880 N UNIVERSITY DR, STE 303, TAMARAC, FL 33321-2124
(954) 340-3000
(954) 636-8407
Mailing address
7880 N UNIVERSITY DR, STE 303, TAMARAC, FL 33321-2124
(954) 340-3000
(954) 636-8407
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME87029
FL
2084P0802X
Addiction Psychiatry Physician
ME87029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268083100
—
FL
Enumeration date
01/14/2013
Last updated
03/27/2013
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