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Dr. Blaine Phillip Boutte, MD
Student in an Organized Health Care Education/Training Program in Broussard, Louisiana
NPI 1699424978

Blaine Phillip Boutte is a Student in an Organized Health Care Education/Training Program based in Broussard, LA. Blaine Phillip Boutte practices in Broussard, LA and has the professional credentials of MD. The NPI Number for Blaine Phillip Boutte is 1699424978 and holds a License No. (Louisiana).

The current practice location address for Blaine Phillip Boutte is 108 Sumter Ave, Broussard, LA and can be reached out via phone at 337-654-1823. You can also correspond with Blaine Phillip Boutte through the mailing address at 108 SUMTER AVE, BROUSSARD, LA - 70518-7312 (mailing address contact number: 337-654-1823).

Location: 108 Sumter Ave, Broussard, LA, 70518-7312
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1699424978
Provider Name
Blaine Phillip Boutte
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
108 Sumter Ave, Broussard, LA, 70518-7312
Phone Number
337-654-1823
Fax Number
Provider Enumeration Date
03/22/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
108 Sumter Ave
City
Broussard
State
Louisiana
Zip
70518-7312
Phone Number
337-654-1823
Fax Number
person
Provider Business Mailing Address Details
Address
108 Sumter Ave
City
Broussard
State
Louisiana
Zip
70518-7312
Phone Number
337-654-1823
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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