Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

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

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: July 19, 2026.

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

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
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

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

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



The typical physician office visit costs for Medicare beneficiaries in this area are: $21.9 for a new patient copayment and $17.51 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 32082 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $87.62
  • Minimum New Patient Price $56
  • Maximum New Patient Price $171.84
  • Average New Patient Copayment $21.9
  • Minimum New Patient Copayment $14
  • Maximum New Patient Copayment $42.96

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $70.04
  • Minimum Established Patient Price $17.57
  • Maximum Established Patient Price $139.16
  • Average Established Patient Copayment $17.51
  • Minimum Established Patient Copayment $4.39
  • Maximum Established Patient Copayment $34.79

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Other Providers at the Same Location


The following 4 providers are registered at the same or a nearby location.

Physician Assistant
103 SOLANA RD STE B
PONTE VEDRA BEACH, FL 32082
Physician Assistant (Medical)
103 SOLANA RD STE B
PONTE VEDRA BEACH, FL 32082
Physician Assistant (Medical)
103 SOLANA RD STE B
PONTE VEDRA BEACH, FL 32082
Specialist
103 SOLANA RD STE B
PONTE VEDRA BEACH, FL 32082

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1689203341, enumerated as an "individual" on April 05, 2020.

The provider is located at 103 SOLANA RD STE B PONTE VEDRA BEACH, FL 32082 and the phone number is (904) 273-2717.

Dermatology with taxonomy code 207N00000X.

The provider might be accepting Accepts: Florida Blue (BlueCross BlueShield FL). Please consult your insurance carrier or call the provider to verify.