Individual
MELISSA KAY BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4920 N INTERSTATE AVE, PORTLAND, OR 97217-3653
(503) 215-3300
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO221767
OR
Other
Enumeration date
03/30/2021
Last updated
10/30/2024
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