Provider Demographics
NPI:1770443871
Name:PREMIER RHEUMATOLOGY, PLLC
Entity type:Organization
Organization Name:PREMIER RHEUMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOURIEL
Authorized Official - Middle Name:DEYANIRA
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-507-6634
Mailing Address - Street 1:4400 W SAMPLE RD STE 236
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3473
Mailing Address - Country:US
Mailing Address - Phone:954-507-6634
Mailing Address - Fax:
Practice Address - Street 1:4400 W SAMPLE RD STE 236
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3473
Practice Address - Country:US
Practice Address - Phone:954-507-6634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty