Jeffrey Boutte, LSA
Specialist/Technologist, Other, Surgical Assistant in Dallas, TX. Individual provider (NPI-1).
NPI number1962639229
StatusActive
Last updated in NPPESAug 26, 2019
Details
- NPI
- 1962639229
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jeffrey Boutte
- Credential
- LSA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 14, 2009
- Last updated
- Aug 26, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | SA00755 | TX | Yes |
Practice location
3210 Rock Bluff DrDallas, TX 75227-5649
Phone 214-364-6769
Mailing address
3210 Rock Bluff DrDallas, TX 75227-5649
Phone 214-364-6769
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