Healthcare Provider Details

I. General information

NPI: 1487635017
Provider Name (Legal Business Name): FLOYD T BOUDREAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

PO BOX 91498
MOBILE AL
36691-1498
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-0326
  • Fax: 251-460-2846
Mailing address:
  • Phone: 251-460-0326
  • Fax: 251-460-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number4218
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: