Provider Demographics
NPI:1205124955
Name:MATTHEW B. BOUDREAUX, M.D., L.L.C.
Entity type:Organization
Organization Name:MATTHEW B. BOUDREAUX, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-0219
Mailing Address - Street 1:1103 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3462
Mailing Address - Country:US
Mailing Address - Phone:337-233-0219
Mailing Address - Fax:337-233-2418
Practice Address - Street 1:1103 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3462
Practice Address - Country:US
Practice Address - Phone:337-233-0219
Practice Address - Fax:337-233-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1214868Medicaid
P00973633OtherRAILROAD MEDICARE
P00973633OtherRAILROAD MEDICARE