Provider Demographics
NPI:1699944272
Name:BAUDOIN, BRUCE PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:PAUL
Last Name:BAUDOIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3805
Mailing Address - Country:US
Mailing Address - Phone:337-237-0436
Mailing Address - Fax:337-265-5032
Practice Address - Street 1:325 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3805
Practice Address - Country:US
Practice Address - Phone:337-237-0436
Practice Address - Fax:337-265-5032
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200056RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant