Individual
DR. PHILIP TREVOR BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2550 N 130TH ST, OMAHA, NE 68164-3466
(402) 214-9148
Mailing address
2550 N 130TH ST, OMAHA, NE 68164-3466
(402) 214-9148
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6504
NE
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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