Boutiette, Lon A

Boutiette, Lon A is an individual health care provider with primary practice located at 1000 Mar Walt Dr , Fort Walton Beach FL 32547-6708. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Boutiette, Lon A can be contacted via phone (850) 863-7607.

Contact Information

Primary practice address
1000 Mar Walt Dr Fort Walton Beach FL 32547-6708
Phone: (850) 863-7607
Fax: (205) 437-5998
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME51154 Florida

Profile Details

NPI number 1174574479
LBN Legal business name Boutiette, Lon A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated May 13th, 2009 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174574479 NPPES
Florida MEDICAID 063236800
Florida Other 059184932
Florida Other 04698
Florida Other 059184934
Florida Other 059184933

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