Provider Demographics
NPI:1609140425
Name:BOUCHER, THOMAS (CNIM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 SUN CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6161
Mailing Address - Country:US
Mailing Address - Phone:916-631-0112
Mailing Address - Fax:
Practice Address - Street 1:11121 SUN CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6161
Practice Address - Country:US
Practice Address - Phone:916-631-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2238OtherABRET CNIM