Individual
PHILIP BOUCHETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 626-0434
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
334420
LA
Other
Enumeration date
04/03/2017
Last updated
09/09/2025
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