Individual
LISSETTE MARIE BOURET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
219 CENTRE ST, MALDEN, MA 02148-5524
(781) 322-7300
Mailing address
219 CENTRE ST, MALDEN, MA 02148-5524
(781) 322-7300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
14725
PR
207Q00000X
Family Medicine Physician
Primary
265252
MA
Other
Enumeration date
09/06/2006
Last updated
08/23/2016
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