Individual
MARK H BOUFFARD IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
72650 FRED WARING DR, SUITE 214, PALM DESERT, CA 92260-5006
(760) 776-7999
(760) 776-7994
Mailing address
72650 FRED WARING DR, SUITE 214, PALM DESERT, CA 92260-5006
(760) 776-7999
(760) 776-7994
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
A89206
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330808867
BLUE CROSS GROUP #
CA
01
—
P00404516
MC RAIL ROAD
CA
Enumeration date
09/25/2006
Last updated
08/12/2019
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