Individual
PHILIP BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 1571, TUBA CITY, AZ 86045-1571
(928) 283-2501
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1312
ME
207Q00000X
Family Medicine Physician
Primary
5022
AZ
Other
Enumeration date
10/24/2006
Last updated
11/03/2011
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