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General NPI Number Information
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NPI Number | 1245419290
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Entity Type | Organization
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Legal Business Name | GEORGE S. BOURGEOIS MD APMC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 519 E PRUDHOMME ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-6499
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Country | US
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Telephone | 337-942-5384
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Fax | 337-942-5301
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Provider Business Mailing Address
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Address Line | 519 E PRUDHOMME ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-6499
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Country | US
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Telephone | 337-942-5384
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Fax | 337-942-5301
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE S BOURGEOIS
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Credential | MD
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Telephone | 337-942-5384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7041
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License Number State | LA
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