Individual
GEOFFREY THOMAS BOUC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3005 RIVERSIDE DR, SUITE 101, BELOIT, WI 53511-1500
(608) 365-7200
(608) 365-7202
Mailing address
3005 RIVERSIDE DR, SUITE 101, BELOIT, WI 53511-1500
(608) 365-7200
(608) 365-7202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36893
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32161500
—
WI
Enumeration date
11/13/2006
Last updated
07/08/2007
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