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General NPI Number Information
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NPI Number | 1871585901
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES BOURGEOIS CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 31003 SHERRIE LN
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City | MAGNOLIA
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State | TX
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Zip | 77354-5793
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Country | US
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Telephone | 281-460-3120
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Fax | 281-259-0879
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Provider Business Mailing Address
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Address Line | 31003 SHERRIE LN
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City | MAGNOLIA
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State | TX
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Zip | 77354-5793
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Country | US
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Telephone | 281-460-3120
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Fax | 281-259-0879
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19119
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 009868L
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 501613
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN051202
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License Number State | LA
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