Individual
ANDREW BRADLEY BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6325 HUMPHREYS BLVD, MEMPHIS, TN 38120-2300
(901) 522-7700
(901) 522-2600
Mailing address
6325 HUMPHREYS BLVD, MEMPHIS, TN 38120-2300
(901) 522-7700
(901) 522-2600
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
29063
MS
207T00000X
Neurological Surgery Physician
Primary
62615
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07507017
—
MS
05
—
Q065607
—
TN
Enumeration date
04/08/2014
Last updated
11/12/2021
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