Individual
DR. BRIAN BOUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1410 SKILLMAN LN, PETALUMA, CA 94952-1249
(707) 696-7427
(707) 615-5775
Mailing address
1410 SKILLMAN LN, PETALUMA, CA 94952-1249
(707) 765-0259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G35969
CA
Other
Enumeration date
09/27/2006
Last updated
07/15/2021
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