Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | PG167669 | OR |
NPI | 1003235706 |
---|---|
Provider Name | Dr. Lauren Elizabeth Boudreaux |
First Address | Corvallis, OR 97330-3737 |
Second Address | Corvallis, OR 97330-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 15/05/2014 |