Boudreaux, Brent
Boudreaux, Brent is an individual health care provider with primary practice located at 2600 Greenwood Rd , Shreveport LA 71103-3908. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Boudreaux, Brent can be contacted via phone (318) 212-4550.Contact Information
Primary practice address
2600 Greenwood Rd
Shreveport LA 71103-3908
Phone: (318) 212-4550
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 017805 | Louisiana |
Profile Details
| NPI number | 1467423913 |
|---|---|
| LBN Legal business name | Boudreaux, Brent |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 31st, 2006 |
| Last updated | Feb 3rd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467423913 | NPPES |
| Louisiana | MEDICAID | 1347264 |
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