Active NPI
David J Boudreaux, PH.D.
- Psychologist
- Tampa, FL
National Provider Identifier
1720501869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 9894
- Practice address
- 10770 N 46TH St BLDG E
Tampa, FL 33617-3442 - Phone
- (813) 631-2583
- Fax
- (813) 631-3581
- NPI assigned
- Jul 20, 2017
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 9894 | FL | Primary |
Addresses
Primary practice location
10770 N 46TH St BLDG E
Tampa, FL 33617-3442
Mailing address
13000 Bruce B Downs Blvd
Tampa, FL 33612-4745
Phone (813) 816-7155
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9894 | FL | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769731200000",
"number": "1720501869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13000 BRUCE B DOWNS BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336124745",
"telephone_number": "813-816-7155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10770 N 46TH ST BLDG E",
"city": "TAMPA",
"state": "FL",
"postal_code": "336173442",
"telephone_number": "813-631-2583",
"fax_number": "813-631-3581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAUX",
"first_name": "DAVID",
"middle_name": "J",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-20",
"last_updated": "2026-01-30",
"certification_date": "2026-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "9894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.