Healthcare Provider Details

I. General information

NPI: 1588637169
Provider Name (Legal Business Name): COASTAL ANESTHESIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST SPRINGHILL MEDICAL CENTER ANESTHESIA DEPT
MOBILE AL
36608-1753
US

IV. Provider business mailing address

PO BOX 851417
MOBILE AL
36685-1417
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-3000
  • Fax: 251-342-3043
Mailing address:
  • Phone: 251-342-3000
  • Fax: 251-342-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL C BOUDREAUX
Title or Position: PRESIDENT
Credential: MD
Phone: 251-342-3000