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General NPI Number Information
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NPI Number | 1063602431
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Entity Type | Individual
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Provider Name | TIFFANY MOORE BOURGEOIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 8212 SUMMA AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3421
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Country | US
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Telephone | 225-769-4403
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Fax | 225-769-3842
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Provider Business Mailing Address
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Address Line | 2012 POINTE SOUTH DR
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City | ZACHARY
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State | LA
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Zip | 70791-5426
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Country | US
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Telephone | 225-202-0946
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD.202681
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2011-00769
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License Number State | NC
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