Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Blake William Boudreaux, MD

Individual provider Dermatology Physician · NPI 1689203341

Dr. Blake William Boudreaux, MD is a Dermatology in Ponte Vedra Beach, Florida. Graduated from Louisiana State University School of Medicine in Shreveport in 2021, 5 years ago. Practices with Beaches Dermatology, PA, a 15-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
5
Trained at
Louisiana State University School of Medicine in Shreveport
Licensed in
FL
In the registry since
2020
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

103 Solana Rd Ste B
Ponte Vedra Beach, FL 32082-2231
Phone: (904) 273-2717
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 791 Amelia Island Pkwy, Fernandina Beach, FL 32034-9126 — (904) 261-7500
  • 614 E Twincourt Trl, St Augustine, FL 32095-9090 — (904) 808-7107

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence ME173977 (FL)

Record details

NPI number1689203341
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 5, 2020
Last updated in NPPESJuly 2, 2026
Certification dateJuly 2, 2026
Mailing address103 Solana Rd Ste B, Ponte Vedra Beach, FL 32082-2231

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated 2021 (5 years in practice)
Group practice Beaches Dermatology, P.A. — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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