Individual
ERIC S BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 MEDICAL DR, TALLAHASSEE, FL 32308-4646
(850) 216-0100
(850) 201-4873
Mailing address
1300 MEDICAL DR, TALLAHASSEE, FL 32308-4646
(850) 216-0100
(850) 201-4873
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME87495
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154344087A
—
GA
05
—
267896900
—
FL
Enumeration date
08/01/2006
Last updated
07/09/2015
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