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

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1235633090

Tyler Gerard Boudreaux is an Internal Medicine in Baton Rouge, Louisiana. Graduated from Louisiana State University School of Medicine in New Orleans in 2018, 8 years ago. Practices with Our Lady of the Lake Physician Group LLC, a 635-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
8
Trained at
Louisiana State University School of Medicine in New Orleans
Licensed in
LA
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

7777 Hennessy Blvd Ste 7000
Baton Rouge, LA 70808-0307
Phone: (225) 765-8829
Fax: (225) 765-8283
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 13505 N Amiss Rd, Baton Rouge, LA 70810-5038 — (225) 757-4097

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 322678 (LA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1235633090
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 19, 2018
Last updated in NPPESAugust 4, 2021
Certification dateAugust 4, 2021

Medicare enrollment

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

Medicare specialtyINTERNAL MEDICINE
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Graduated 2018 (8 years in practice)
Group practice Our Lady Of The Lake Physician Group Llc — 635 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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