Healthcare Provider Details

I. General information

NPI: 1740468560
Provider Name (Legal Business Name): F JOHN BOURGEOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W LEE HWY
WARRENTON VA
20186-2149
US

IV. Provider business mailing address

75 W LEE HWY
WARRENTON VA
20186-2149
US

V. Phone/Fax

Practice location:
  • Phone: 540-351-0662
  • Fax:
Mailing address:
  • Phone: 540-351-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101032325
License Number StateVA

VIII. Authorized Official

Name: FRANCIS JOHN BOURGEOIS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 540-351-0662