Individual
SALVADOR ANGEL BOU-GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1507 W REYNOLDS ST STE A, PLANT CITY, FL 33563-4702
(813) 719-3716
(813) 759-2487
Mailing address
1507 W REYNOLDS ST STE A, PLANT CITY, FL 33563-4702
(813) 719-3716
(813) 759-2487
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME64556
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23602
BCBS
—
05
—
374065000
—
FL
01
—
ME64556
ME
—
Enumeration date
11/17/2005
Last updated
04/09/2018
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