Dr. Clarence E Boudreaux
Dermatologist
103 Solana Road Suite B
Ponte Vedra Beach
, Florida 32082
Dr. Clarence E Boudreaux
Dermatologist
103 Solana Road Suite B
Ponte Vedra Beach
, Florida 32082
(904) 273-0410
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Dr. Clarence E Boudreaux
- 103 Solana Road Suite B
- Ponte Vedra Beach, FL
- Zip : 32082
- Fax : (904) 273-0410
- Phone : (904) 273-2717
Second Address
- Dr. Clarence E Boudreaux
- 103 Solana Road Suite B
- Ponte Vedra Beach, FL
- Zip : 32082
- Fax : (904) 273-0410
- Phone : (904) 273-2717
Reviews
FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | ME0055674 | FL |
National Provider Identifier
| NPI | 1053366211 |
|---|---|
| Provider Name | Dr. Clarence E Boudreaux |
| First Address | Ponte Vedra Beach, FL 32082 |
| Second Address | Ponte Vedra Beach, FL 32082 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/05/2006 |
| Last Update Date | 15/01/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| D79767 | (02) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.