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General NPI Number Information
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NPI Number | 1447202718
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Entity Type | Individual
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Provider Name | WILLIAM A BOURLAND MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 222 N 2ND ST STE 112
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City | BOISE
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State | ID
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Zip | 83702-6109
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Country | US
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Telephone | 208-947-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 222 N 2ND ST STE 112
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City | BOISE
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State | ID
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Zip | 83702-6109
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Country | US
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Telephone | 208-947-0988
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M5187
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | M5187
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License Number State | ID
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