Provider Demographics
NPI:1336358670
Name:BOUDREAUX, BRIDGET A (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N JEFFERSON DAVIS PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5308
Mailing Address - Country:US
Mailing Address - Phone:504-821-0244
Mailing Address - Fax:504-821-0255
Practice Address - Street 1:120 N JEFFERSON DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5308
Practice Address - Country:US
Practice Address - Phone:504-821-0244
Practice Address - Fax:504-821-0255
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL#1725207Y00000X
TXN2413207Y00000X
LAMD.207821207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology