MEDICARE: ROBERT SIDNEY BOURGEOIS M.D.

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	207Q00000X	Family Medicine Physician	ME34882	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083616940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SIDNEY BOURGEOIS M.D.

Provider Business Mailing Address
First Line	:	12915 KEDLESTON CIRCLE
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33912
Country	:	US
Telephone Number	:	239-826-3578
Fax Number	:	239-931-6125

Provider Business Practice Location Address
First Line	:	3033 WINKLER EXTENSION
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33916
Country	:	US
Telephone Number	:	239-939-3939
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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