Active NPI
Gary Lamon Boudreaux, DDS
- General Practice Dentistry
- El Paso, TX
National Provider Identifier
1154550135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10100
- Practice address
- 8815 Dyer St Ste 255
El Paso, TX 79904-2033 - Phone
- (915) 757-2688
- Fax
- (915) 757-2689
- NPI assigned
- Jul 10, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10100 | TX | Primary |
Addresses
Primary practice location
8815 Dyer St Ste 255
El Paso, TX 79904-2033
Mailing address
8815 Dyer St Ste 255
El Paso, TX 79904-2033
Phone (915) 757-2688
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10100 | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247184000000",
"number": "1154550135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8815 DYER ST STE 255",
"city": "EL PASO",
"state": "TX",
"postal_code": "799042033",
"telephone_number": "915-757-2688",
"fax_number": "915-757-2689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8815 DYER ST STE 255",
"city": "EL PASO",
"state": "TX",
"postal_code": "799042033",
"telephone_number": "915-757-2688",
"fax_number": "915-757-2689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAUX",
"first_name": "GARY",
"middle_name": "LAMON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-10",
"last_updated": "2009-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "10100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.