Provider Demographics
NPI:1952398547
Name:BOUFFARD, AMADA S (MD)
Entity Type:Individual
Prefix:
First Name:AMADA
Middle Name:S
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMADA
Other - Middle Name:
Other - Last Name:SARNATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3000
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:916 HWY 542
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4198
Practice Address - Country:US
Practice Address - Phone:863-419-3330
Practice Address - Fax:863-419-3258
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23856207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055818400Medicaid
FL71379OtherBLUE CROSS BLUE SHIELD
FL71379VMedicare PIN
FLD58045Medicare Oscar/Certification
D58045Medicare UPIN
FL71379XMedicare PIN
FL71379WMedicare PIN
FL055818400Medicaid