Individual
DR. JEAN-DENIS BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11101 TOEPPERWEIN RD, LIVE OAK, TX 78233-3143
(210) 651-3233
(210) 651-3234
Mailing address
PO BOX 3112, UNIVERSAL CITY, TX 78148-2212
(210) 651-3233
(210) 651-3234
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
K8022
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0043QR
BC/BS PROVIDER ID
TX
01
—
4219937
BC/BS BLUE LINK I.D.
TX
Enumeration date
11/04/2005
Last updated
04/22/2021
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