Provider Demographics
NPI:1922537778
Name:BOUCHELLE, ZOE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:MARIE
Last Name:BOUCHELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:DENVER HEALTH DEPARTMENT OF PEDIATRICS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:DENVER HEALTH DEPARTMENT OF PEDIATRICS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:410-960-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213903208000000X
CODR.0070581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics