Provider Demographics
NPI:1942378666
Name:BOUCHER, RICHARD DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DONALD
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1718
Mailing Address - Country:US
Mailing Address - Phone:562-420-9520
Mailing Address - Fax:
Practice Address - Street 1:800 N. STATE COLLEGE BLVD.
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92834-6830
Practice Address - Country:US
Practice Address - Phone:714-278-2800
Practice Address - Fax:714-278-3069
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 36799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine