Individual
JOSE ANTONIO BOUFFARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
261 MACK AVE, ROOM 215, DETROIT, MI 48201-2417
(313) 966-2539
(313) 993-2630
Mailing address
261 MACK AVE, ROOM 215, DETROIT, MI 48201-2417
(313) 966-2539
(313) 993-2630
Taxonomy
Speciality
Code
Description
License number
State
207UN0902X
Nuclear Imaging & Therapy Physician
Primary
4301044748
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JB044748
STATE LICENSURE
MI
Enumeration date
12/01/2006
Last updated
09/08/2014
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