Provider Demographics
NPI:1265440721
Name:BOUTIN, FRANK J JR (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:BOUTIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:916-733-5714
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG63508207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2262774OtherFIRST HEALTH
CA3760246OtherCIGNA
CA544409OtherGREAT WEST
CA00G635080OtherBLUE SHIELD
CA1049186OtherUNITED
CA90022511OtherPACIFICARE
CA4272800OtherAETNA
CA78505OtherFIRST HEALTH
CA000810354263OtherPHCS
CA00G635080Medicaid
CAMCMG167800OtherWESTERN HEALTH ADVANTAGE
CA35155OtherINTERPLAN
CA501694OtherHEALTH NET
CAG63508OtherBLUE CROSS
CAMCMG167800OtherWESTERN HEALTH ADVANTAGE
CA3760246OtherCIGNA