Provider Demographics
NPI:1891719688
Name:BOUCHER, WILLIAM F JR (MD,MPH, FACOEM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:BOUCHER
Suffix:JR
Gender:M
Credentials:MD,MPH, FACOEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5424
Mailing Address - Country:US
Mailing Address - Phone:207-879-0404
Mailing Address - Fax:207-879-0606
Practice Address - Street 1:725 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5424
Practice Address - Country:US
Practice Address - Phone:207-879-0404
Practice Address - Fax:207-879-0606
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME120282083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine