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DR. DAVID JEAN-GUY BOUDREAULT M.D.
NPI 1609057884
Specialist in Palo Alto, CA

Active since November 16, 2007Opted out of Medicare · through Apr 12, 2027
1515 EL CAMINO REAL STE C, PALO ALTO, CA 94306(650) 433-8621(650) 434-0061 Get Directions Write a Review

NPPES record last updated: May 4, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. David Jean-guy Boudreault M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DAVID JEAN-GUY BOUDREAULT M.D. (NPI 1609057884) is an individual specialist in Palo Alto, California, licensed in California (A98186) and active in the NPI registry since November 2007. He has opted out of Medicare through April 12, 2027.

NPPES Registry Identity

NPI1609057884
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameDR. DAVID JEAN-GUY BOUDREAULTCredential: M.D.
Location Address1515 EL CAMINO REAL STE CPalo Alto, CA 94306-1000
Mailing Address1515 El Camino Real Ste CPalo Alto, CA 94306-1000 · (650) 433-8621 · Fax (650) 434-0061
Phone(650) 433-8621
Fax(650) 434-0061
Sole ProprietorYes
Enumeration DateNovember 16, 2007
Last NPPES UpdateMay 4, 2016
✔ NPI 1609057884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · A98186
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

1515 EL CAMINO REAL STE C, Palo Alto, CA 94306
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. David Jean-guy Boudreault M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 12, 2021 through April 12, 2027.

Opt-Out Effective DateApril 12, 2021
Opt-Out In Effect ThroughApril 12, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ILLUMINATE PLASTIC SURGERY, INC
Clinic/Center (Medical Specialty)
1515 EL CAMINO REAL STE C
PALO ALTO, CA 94306
Santa Clara County (650) 433-8621

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is David Boudreault's NPI number?

The NPI number for David Boudreault is 1609057884. It was assigned to this individual provider in the NPPES registry on November 16, 2007.

Where is David Boudreault located?

David Boudreault practices at 1515 El Camino Real Ste C, Palo Alto, CA 94306. The listed phone number is (650) 433-8621.

What is David Boudreault's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is David Boudreault enrolled in Medicare?

No. David Boudreault has opted out of Medicare through April 12, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for David Boudreault was last updated on May 4, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.