Individual
JOHN WILLIAM BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1230 7TH AVE, LONGVIEW, WA 98632-3166
(360) 636-2400
Mailing address
1230 7TH AVE, LONGVIEW, WA 98632-3166
(360) 636-2400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00021715
WA
207Q00000X
Family Medicine Physician
MD23802
OR
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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