Healthcare Provider Details

I. General information

NPI: 1831182732
Provider Name (Legal Business Name): JOSEPH D BOUVIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD BLDG C, ROOM 2240
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-4689
  • Fax: 602-546-4683
Mailing address:
  • Phone: 602-546-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27900
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: