Provider Demographics
NPI:1174942320
Name:BOUCHER, DULCE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:DULCE
Middle Name:ELIZABETH
Last Name:BOUCHER
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 1:30 N 1900 E
Mailing Address - Street 2:ROOM 3C444
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2501
Mailing Address - Country:US
Mailing Address - Phone:801-581-6393
Mailing Address - Fax:801-581-4367
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:ROOM 3C444
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2501
Practice Address - Country:US
Practice Address - Phone:801-581-6393
Practice Address - Fax:801-581-4367
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT9529140-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program