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General NPI Number Information
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NPI Number | 1457342842
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Entity Type | Individual
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Provider Name | MICHAEL BOURGEOIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 4102 24TH ST STE 507
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City | LUBBOCK
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State | TX
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Zip | 79410-1805
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Country | US
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Telephone | 806-743-7334
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Fax | 806-743-7332
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Provider Business Mailing Address
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Address Line | PO BOX 5865
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City | LUBBOCK
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State | TX
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Zip | 79408-5865
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Country | US
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Telephone | 806-743-2898
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Fax | 806-743-2787
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | F5842
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | F5842
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License Number State | TX
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