Individual
MR. BRYAN EDWARD BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2ND TANK BATTALION, CAMP LEJEUNE, NC 28542
(910) 449-9092
Mailing address
801 BRYNN MARR RD, JACKSONVILLE, NC 28546-7608
(910) 346-1512
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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