Individual
DAVID BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4204
Mailing address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4204
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G4848
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010016274
RAILROAD MEDICARE PROV NO
TX
05
—
123772901
—
TX
01
—
2060508001
CIGNA PROVIDER NUMBER
TX
01
—
72486303
UNITED HEALTHCARE PROV NO
TX
01
—
814765
BCBS PROVIDER NUMBER
TX
Enumeration date
06/16/2005
Last updated
10/06/2022
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