Active NPI
Stephen Patrick Bolduc, M.D.
- Pediatrics Physician
- Santa Rosa Beach, FL
National Provider Identifier
1740233170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME121545
- Practice address
- 23 Mack Bayou Loop
Suite 200
Santa Rosa Beach, FL 32459-2606 - Phone
- (850) 278-3920
- Fax
- (850) 278-3919
- NPI assigned
- May 18, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME121545 | FL | Primary |
Addresses
Primary practice location
23 Mack Bayou Loop
Suite 200
Santa Rosa Beach, FL 32459-2606
Mailing address
PO Box 2699
Pensacola, FL 32513-2699
Phone (850) 278-3920
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME121545 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451347200000",
"number": "1740233170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2699",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325132699",
"telephone_number": "850-278-3920",
"fax_number": "850-278-3919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 MACK BAYOU LOOP",
"address_2": "SUITE 200",
"city": "SANTA ROSA BEACH",
"state": "FL",
"postal_code": "324592606",
"telephone_number": "850-278-3920",
"fax_number": "850-278-3919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDUC",
"first_name": "STEPHEN",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2015-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME121545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.