Individual
JEROMY TRAVIS BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2150 PENNSYLVANIA AVE NW, WASHINGTON, DC 20037-3201
(202) 741-3000
Mailing address
2150 PENNSYLVANIA AVE NW, WASHINGTON, DC 20037-3201
(202) 741-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0102204042
VA
207P00000X
Emergency Medicine Physician
DO.1213
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/26/2010
Last updated
10/18/2018
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