Provider Demographics
NPI:1851833396
Name:CHESTER G BOUDREAUX MD INC
Entity Type:Organization
Organization Name:CHESTER G BOUDREAUX MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-446-2131
Mailing Address - Street 1:142 RUE MARGUERITE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6708
Mailing Address - Country:US
Mailing Address - Phone:985-446-2131
Mailing Address - Fax:985-447-3383
Practice Address - Street 1:142 RUE MARGUERITE
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6708
Practice Address - Country:US
Practice Address - Phone:985-446-2131
Practice Address - Fax:985-447-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty