Provider Demographics
NPI:1063273035
Name:LINDA J BOUCHARD MD, INC
Entity type:Organization
Organization Name:LINDA J BOUCHARD MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:098-604-3932
Mailing Address - Street 1:520 E. CENTER ST.
Mailing Address - Street 2:MANTECA, CA 95336-4720
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4720
Mailing Address - Country:US
Mailing Address - Phone:209-860-4393
Mailing Address - Fax:
Practice Address - Street 1:520 E. CENTER ST.
Practice Address - Street 2:MANTECA, CA 95336-4720
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4720
Practice Address - Country:US
Practice Address - Phone:209-860-4393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty