Individual
MR. BRADLEY SCOTT BOUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
836 PRUDENTIAL DRIVE, STE 1804, JACKSONVILLE, FL 32207-8345
(904) 398-3888
(904) 400-6675
Mailing address
836 PRUDENTIAL DRIVE, STE 1804, JACKSONVILLE, FL 32207-8345
(904) 398-3888
(904) 400-6675
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9115278
FL
Other
Enumeration date
01/03/2022
Last updated
03/31/2025
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