Doctor Name: | ORLAND KENTON BOUCHER |
NPI Number: | 1013037357 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 010398 |
Business Practice Address: | 13400 E Shea Blvd Scottsdale, AZ - 852595404 |
Business Phone Number: | 4803018000 |
Business Fax Number: | |
Mailing Address: | 13400 E Shea Blvd, SCOTTSDALE |
State: | AZ |
Postal Code: | 852595404 |
Phone Number: | 4803018000 |
Fax Number: | |
NPI Enumeration Date: | 03/30/2007 |
NPI Last Update Date: | 10/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 010398 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |