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NPI Code Detail

MEDICARE: PAUL A LEBOURGEOIS MD

MEDICARE: PAUL A LEBOURGEOIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianE5566TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180P645OTHERBCBS OF TEXAS

General Provider Information

NPI Number : 1841271962
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL A LEBOURGEOIS MD
Provider Business Mailing Address
First Line : PO BOX 164106
Second Line :
City : AUSTIN
State : TX
Zip : 78716-4106
Country : US
Telephone Number : 512-448-7100
Fax Number : 512-416-6409
Provider Business Practice Location Address
First Line : 901 W BEN WHITE BLVD
Second Line : SOUTH AUSTIN HOSPITAL PATHOLOGY DEPARTMENT
City : AUSTIN
State : TX
Zip : 78704-6903
Country : US
Telephone Number : 512-448-7100
Fax Number : 512-416-6409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 07/08/2007

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