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General NPI Number Information
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NPI Number | 1588936702
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Entity Type | Organization
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Legal Business Name | JOSEPH B BOUCREE JR INC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 1570 LINDBERG DR STE 8
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City | SLIDELL
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State | LA
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Zip | 70458-8084
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Country | US
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Telephone | 985-205-3456
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Fax | 985-288-0047
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Provider Business Mailing Address
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Address Line | 1570 LINDBERG DR STE 8
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City | SLIDELL
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State | LA
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Zip | 70458-8084
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Country | US
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Telephone | 985-205-3456
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Fax | 985-288-0047
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Authorized Official
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Title or Position | FRONT OFFICE MANAGER
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Name | KIM RYALS
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Credential |
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Telephone | 985-205-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 020305
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License Number State | LA
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