Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 200583 | LA |
NPI | 1083655237 |
---|---|
Provider Name | Angele D. Bourg |
First Address | Baton Rouge, LA 70808-4326 |
Second Address | Baton Rouge, LA 70808-4326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 27/02/2017 |