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NPI Code Detail

MEDICARE: DR. MAURICE LOUIS BOUCHARD M.D.

MEDICARE: DR. MAURICE LOUIS BOUCHARD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME0056671FL
2208800000XUrology PhysicianME56671FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154308104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAURICE LOUIS BOUCHARD M.D.
Provider Business Mailing Address
First Line : 4724 N DAVIS HWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2339
Country : US
Telephone Number : 850-696-4000
Fax Number : 850-444-7057
Provider Business Practice Location Address
First Line : 4724 N DAVIS HWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2339
Country : US
Telephone Number : 850-696-4000
Fax Number : 850-444-7057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 06/20/2014

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