Provider Demographics
NPI:1982805339
Name:BOUCHER, SARAH ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5323
Mailing Address - Country:US
Mailing Address - Phone:469-814-6631
Mailing Address - Fax:469-814-3110
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-6631
Practice Address - Fax:469-814-3110
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241159207R00000X
TXP0554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2859027-02Medicaid
TX2859027-02Medicaid