Individual
DR. MARK DANIEL BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 NE BLAKELY DR STE 5010, ISSAQUAH, WA 98029-6201
(425) 394-0700
(425) 394-0757
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD61046264
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316392517
—
WA
Enumeration date
04/26/2016
Last updated
01/17/2022
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