MEDICARE: AMADA S BOUFFARD MD

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
1	207V00000X	Obstetrics & Gynecology Physician	ME23856	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	71379	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952398547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMADA S BOUFFARD MD

Provider Business Mailing Address
First Line	:	950 COUNTY ROAD 17A W
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2164
Country	:	US
Telephone Number	:	863-452-3000
Fax Number	:	863-452-3069

Provider Business Practice Location Address
First Line	:	916 HWY 542
Second Line	:
City	:	DUNDEE
State	:	FL
Zip	:	33838-4198
Country	:	US
Telephone Number	:	863-419-3330
Fax Number	:	863-419-3258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	05/22/2008

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