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General NPI Number Information
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NPI Number | 1053413583
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Entity Type | Individual
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Provider Name | LEONARD JB BOURGEOIS SR. MD
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Gender | Male
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1409 CHURCH ST
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City | JEANERETTE
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State | LA
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Zip | 70544-4407
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Country | US
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Telephone | 337-276-6018
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Fax | 337-276-9507
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Provider Business Mailing Address
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Address Line | PO BOX 910
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City | JEANERETTE
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State | LA
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Zip | 70544-0910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017806
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License Number State | LA
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