Provider Demographics
NPI:1922637586
Name:BOUDREAUX, CHRISTIAN MARTIN
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:MARTIN
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 LAKEVIEW DR APT 1108
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6102
Mailing Address - Country:US
Mailing Address - Phone:512-665-4639
Mailing Address - Fax:
Practice Address - Street 1:3109 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5548
Practice Address - Country:US
Practice Address - Phone:863-386-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant