MEDICARE: DR. STEPHEN PATRICK BOLDUC M.D.

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	208000000X	Pediatrics Physician	ME121545	FL

General Provider Information

NPI Number	:	1740233170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PATRICK BOLDUC M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2699
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2699
Country	:	US
Telephone Number	:	850-278-3920
Fax Number	:	850-278-3919

Provider Business Practice Location Address
First Line	:	23 MACK BAYOU LOOP
Second Line	:	SUITE 200
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-2606
Country	:	US
Telephone Number	:	850-278-3920
Fax Number	:	850-278-3919

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	12/29/2015

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