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General NPI Number Information
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NPI Number | 1629251012
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Entity Type | Organization
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Legal Business Name | JOHN M. BOURAS, MD, PA
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Dates
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Enumeration Date | 12/09/2007
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 2705 HOSPITAL DR STE 206
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City | VICTORIA
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State | TX
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Zip | 77901-5775
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Country | US
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Telephone | 361-574-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 HOSPITAL DR STE 206
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City | VICTORIA
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State | TX
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Zip | 77901-5775
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Country | US
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Telephone | 361-574-1899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BOURAS JOHN
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Credential |
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Telephone | 361-574-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M5069
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License Number State | TX
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