Active NPI
Richard Donald Boucher, M.D.
- Family Medicine Physician
- Fullerton, CA
National Provider Identifier
1942378666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A 36799
- Practice address
- 800 N. State College Blvd.
Fullerton, CA 92834-6830 - Phone
- (714) 278-2800
- Fax
- (714) 278-3069
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A 36799 | CA | Primary |
Addresses
Primary practice location
800 N. State College Blvd.
Fullerton, CA 92834-6830
Mailing address
3526 Clark Ave
Long Beach, CA 90808-1718
Phone (562) 420-9520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A 36799 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942378666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3526 CLARK AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081718",
"telephone_number": "562-420-9520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N. STATE COLLEGE BLVD.",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928346830",
"telephone_number": "714-278-2800",
"fax_number": "714-278-3069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "RICHARD",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A 36799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.