Individual
DR. AXEL BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
13099 S CLEVELAND AVE STE 300, FORT MYERS, FL 33907-3835
(239) 936-1336
Mailing address
13099 S CLEVELAND AVE STE 300, FORT MYERS, FL 33907-3835
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY10473
FL
103T00000X
Psychologist
PY10473
FL
Other
Enumeration date
04/27/2015
Last updated
08/20/2019
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