Provider Demographics
NPI:1972009868
Name:BOUCHER, MOURIEL DEYANIRA (DO)
Entity Type:Individual
Prefix:
First Name:MOURIEL
Middle Name:DEYANIRA
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 SUNSET DR STE 501
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4870
Mailing Address - Country:US
Mailing Address - Phone:305-671-3447
Mailing Address - Fax:
Practice Address - Street 1:6280 SUNSET DR STE 501
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4870
Practice Address - Country:US
Practice Address - Phone:305-671-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20011207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology