Provider Demographics
NPI:1861436081
Name:BOUCHARD, JULIA K (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:K
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5189
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:6140 W CURTISIAN
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-367-4224
Practice Address - Fax:208-367-7806
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8138207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805860000Medicaid
ID1145047Medicare ID - Type Unspecified
ID805860000Medicaid