MEDICARE: DR. JUDY LYNN BOURGET MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G72076	CA
2	208600000X	Surgery Physician	G72076	CA

General Provider Information

NPI Number	:	1073593240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY LYNN BOURGET MD

Provider Business Mailing Address
First Line	:	34052 LA PLZ
Second Line	:	SUITE 104
City	:	DANA POINT
State	:	CA
Zip	:	92629-2587
Country	:	US
Telephone Number	:	949-429-8760
Fax Number	:	949-429-6909

Provider Business Practice Location Address
First Line	:	34052 LA PLZ
Second Line	:	SUITE 104
City	:	DANA POINT
State	:	CA
Zip	:	92629-2587
Country	:	US
Telephone Number	:	949-429-8760
Fax Number	:	949-429-6909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	02/03/2010

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