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Contact Information

BLAKE W BOUDREAUX, MD
103 SOLANA RD STE B
PONTE VEDRA BEACH, FL32082-2231
 Phone: 904-273-2717
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for BLAKE W BOUDREAUX · (Male)

NPI # 1689203341
Status Active
Credentials MD
Entity Individual
Enumeration date 04/05/2020
Last updated 05/29/2026 - Less than a week ago
Sole proprietor 1 No
Identifiers
  • FL License # ME173977
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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