Individual
DR. KENT ANDREW BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 703-5011
Mailing address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 703-5011
(575) 784-6028
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
S2734
TX
208D00000X
General Practice Physician
S2734
TX
Other
Enumeration date
03/26/2018
Last updated
06/26/2023
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