Provider Demographics
NPI:1285847087
Name:BOUDREAUX, LYNZIE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:LYNZIE
Middle Name:ELIZABETH
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 INDEST ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-1719
Mailing Address - Country:US
Mailing Address - Phone:337-365-0268
Mailing Address - Fax:337-369-6922
Practice Address - Street 1:295 INDEST ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-1719
Practice Address - Country:US
Practice Address - Phone:337-365-0268
Practice Address - Fax:337-369-6922
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 203743208M00000X, 208000000X
LAMD.203743208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist