Organization
BOUTIQUE BREAST IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN PEARSON PEYTON MD (MANAGER)
(904) 553-8806
Entity
Organization
Contact information
Practice address
6871 BELFORT OAKS PL, JACKSONVILLE, FL 32216-6242
(904) 553-8806
Mailing address
823 WATERMAN RD N, JACKSONVILLE, FL 32207-5240
(904) 553-8806
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Enumeration date
09/28/2023
Last updated
10/02/2023
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