Individual
JASON GRADY BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7777 HENNESSY BLVD STE 701, BATON ROUGE, LA 70808-4370
(225) 765-8648
(225) 765-7898
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-8648
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
301495
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301495
STATE LICENSE
LA
05
—
6199064
—
LA
Enumeration date
03/20/2012
Last updated
07/01/2024
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