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NPI Code Detail

MEDICARE: MR. DAVID MICHAEL BOUDREAUX CRNA

MEDICARE: MR. DAVID MICHAEL BOUDREAUX CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN036422 APO2191LA
2367500000XCertified Registered Nurse Anesthetist031963TX
3367500000XCertified Registered Nurse AnesthetistARNP9285473FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00731625OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063494722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID MICHAEL BOUDREAUX CRNA
Provider Business Mailing Address
First Line : 902 N HENNESSEY ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70119-3622
Country : US
Telephone Number : 504-488-1409
Fax Number : 504-483-3277
Provider Business Practice Location Address
First Line : 902 N HENNESSEY ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70119-3622
Country : US
Telephone Number : 504-488-1409
Fax Number : 504-483-3277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 08/08/2012

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