Active NPI
David Jean-Guy Boudreault, M.D.
- Specialist
- Palo Alto, CA
National Provider Identifier
1609057884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A98186
- Practice address
- 1515 El Camino Real Ste C
Palo Alto, CA 94306-1000 - Phone
- (650) 433-8621
- Fax
- (650) 434-0061
- NPI assigned
- Nov 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | A98186 | CA | Primary |
Addresses
Primary practice location
1515 El Camino Real Ste C
Palo Alto, CA 94306-1000
Mailing address
1515 El Camino Real Ste C
Palo Alto, CA 94306-1000
Phone (650) 433-8621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 12, 2021 through Apr 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A98186 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462320000000",
"number": "1609057884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 EL CAMINO REAL STE C",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943061000",
"telephone_number": "650-433-8621",
"fax_number": "650-434-0061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 EL CAMINO REAL STE C",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943061000",
"telephone_number": "650-433-8621",
"fax_number": "650-434-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAULT",
"first_name": "DAVID",
"middle_name": "JEAN-GUY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-16",
"last_updated": "2016-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A98186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.