Most Relevant Information
Provider Data
| NPI Number: | 1003557950 |
| Provider Name: | BRANT DERWENT BOUCHER MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/05/2022 |
| Last Updated: | 04/05/2022 |
Provider Practice Location
171 TAYLOR ST
HARPERS FERRY
WV
254253641
Practice Location Phone/Fax
| Phone: | 3045356343 |
| Fax: | 3045962840 |
Provider Mailing Location
171 TAYLOR ST
HARPERS FERRY
WV
254253641
Provider Mailing Phone/Fax
| Phone: | 3045356343 |
| Fax: | 3045962840 |