Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. BLAKE WILLIAM BOUDREAUX MD
NPI 1689203341
Dermatology in Ponte Vedra Beach, FL

Q: What is Blake Boudreaux's NPI number?

The NPI number for Blake Boudreaux is 1689203341. It was assigned to this individual provider in the NPPES registry on April 5, 2020.

Q: What is Blake Boudreaux's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Q: When was this NPI record last updated?

The NPPES record for Blake Boudreaux was last updated on July 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 44 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 05, 2020PECOS EnrolledAccepts Medicare Assignment

103 SOLANA RD STE B, PONTE VEDRA BEACH, FL 32082(904) 273-2717 Get Directions Write a Review

NPPES record last updated: July 2, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 29, 2026, May 18, 2025, Apr 5, 2020 (3 updates tracked since 2020).

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About Dr. Blake William Boudreaux Md NPPES

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

DR. BLAKE WILLIAM BOUDREAUX MD (NPI 1689203341) is an individual dermatology provider in Ponte Vedra Beach, Florida, licensed in Florida (ME173977) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Louisiana State University School Of Medicine In Shreveport (2021).

NPPES Registry Identity

NPI1689203341

Entity TypeIndividualMale

Primary Taxonomy207N00000X

Provider Legal NameDR. BLAKE WILLIAM BOUDREAUXCredential: MD

Location Address103 SOLANA RD STE BPonte Vedra Beach, FL 32082-2231

Mailing Address103 Solana Rd Ste BPonte Vedra Beach, FL 32082-2231 · (904) 273-2717 · Fax (904) 273-0410

Phone(904) 273-2717

Sole ProprietorNo

Medical School CMSLouisiana State University School Of Medicine In ShreveportGraduated 2021

Enumeration DateApril 5, 2020

Last NPPES UpdateJuly 2, 20263 updates tracked since enumeration

NPPES CertifiedJuly 2, 2026

✔ NPI 1689203341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in FL · ME173977

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

103 SOLANA RD STE B, Ponte Vedra Beach, FL 32082

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Secondary Practice Locations 2

Location 1614 E Twincourt TrlSt Augustine, FL 32095-9090 · Phone (904) 808-7107

Location 2791 Amelia Island PkwyFernandina Beach, FL 32034-9126 · Phone (904) 261-7500

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL).Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Blake William Boudreaux Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6406278951

PECOS Enrollment IDI20250717003352

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32082 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

BAO YANG PA-C

Physician Assistant (Medical)