SearchIllinois183500000X

Bret Boucher

NPI 1285061887 · on the registry since 2013

Practice

Address
901 W Lake Ave
Peoria, IL 61614
Phone
(309) 682-2761
Fax
(309) 682-4267
Clinicians at this address
2

Registry record

Primary taxonomy
183500000X
183500000X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2013-09-27

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois