Individual
DR. EDWARD W. BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6983 E FOWLER AVE, TAMPA, FL 33617-1714
(813) 899-6226
(813) 985-8006
Mailing address
PO BOX 47509, TAMPA, FL 33647-0113
(813) 899-6226
(813) 985-8006
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME89261
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269312700
—
FL
Enumeration date
10/17/2006
Last updated
07/08/2007
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