MEDICARE: FRED BOUDREAUX

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	237600000X	Audiologist-Hearing Aid Fitter	80185	TX

General Provider Information

NPI Number	:	1669760575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED BOUDREAUX

Provider Business Mailing Address
First Line	:	26222 RR 12
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4903
Country	:	US
Telephone Number	:	512-858-0300
Fax Number	:	512-858-2714

Provider Business Practice Location Address
First Line	:	26222 RR 12
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4903
Country	:	US
Telephone Number	:	512-858-0300
Fax Number	:	512-858-2714

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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Directions to “ FRED BOUDREAUX ” Practice Location

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