Organization
BEACHES DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE E BOUDREAUX M.D. (PRESIDENT)
(904) 273-2717
Entity
Organization
Contact information
Practice address
103 SOLANA RD, SUITE B, PONTE VEDRA BEACH, FL 32082-2231
(904) 273-2717
Mailing address
103 SOLANA RD, SUITE B, PONTE VEDRA BEACH, FL 32082-2231
(904) 273-2717
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207N00000X
FL
Other
Enumeration date
06/13/2006
Last updated
01/10/2017
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