Provider Demographics
NPI:1811076995
Name:BOUDREAUX, BRAD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALAN
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3619 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLDG E
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5132
Mailing Address - Country:US
Mailing Address - Phone:337-534-4410
Mailing Address - Fax:337-534-4426
Practice Address - Street 1:3619 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BLDG E
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5132
Practice Address - Country:US
Practice Address - Phone:337-534-4410
Practice Address - Fax:337-534-4426
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.201157208D00000X
LA201157207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1091570Medicaid
LA4K379CQ60Medicare PIN