Bryan Edward Bouchard, idc
Military Health Care Provider, Independent Duty Corpsman in Camp Lejeune, NC. Individual provider (NPI-1).
NPI number1861692857
StatusActive
Last updated in NPPESJul 19, 2007
Details
- NPI
- 1861692857
- Entity type
- Individual (NPI-1)
- Name
- Mr. Bryan Edward Bouchard
- Credential
- idc
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 19, 2007
- Last updated
- Jul 19, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
2nd Tank BattalionCamp Lejeune, NC 28542
Phone 910-449-9092
Mailing address
801 Brynn Marr RdJacksonville, NC 28546-7608
Phone 910-346-1512
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