Healthcare Provider Details

I. General information

NPI: 1508779380
Provider Name (Legal Business Name): JOAO BOURBON DE ALBUQUERQUE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 MINISTRO GERALDO BARRETO SOBRAL AVE SUITE 104
ARACAJU SERGIPE
4902010
BR

IV. Provider business mailing address

500 MONSENHOR OLIVIO TEIXEIRA ST APARTMENT 501
ARACAJU SE - SERGIPE
49026225
BR

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2026046231
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: