Healthcare Provider Details

I. General information

NPI: 1639199698
Provider Name (Legal Business Name): THOMAS HENRY BURGUIERES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

9117 FERNWOOD RD
BETHESDA MD
20817-3019
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4438
  • Fax:
Mailing address:
  • Phone: 240-994-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD22966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: