Provider Demographics
NPI:1831458363
Name:BUDDEN, BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:BUDDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SETTLERS TRACE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6090
Mailing Address - Country:US
Mailing Address - Phone:337-524-1700
Mailing Address - Fax:337-524-1702
Practice Address - Street 1:91 SETTLERS TRACE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6090
Practice Address - Country:US
Practice Address - Phone:337-524-1700
Practice Address - Fax:337-524-1702
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306292207N00000X
LA008212132390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program