Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D8154 | TX |
Y | 111NI0900X | Internist | D8154 | TX |
N | 207RG0300X | Geriatric Medicine | D8154 | TX |
NPI | 1063414134 |
---|---|
Provider Name | Cecil M Bourne |
First Address | Corpus Christi, TX 78404-2338 |
Second Address | Corpus Christi, TX 78404-2338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 18/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00823K | BLUE CROSS (01) | TX |
081210901 | (05) | TX |
110184080 | MEDICARE RAILROAD (01) | TX |
82N381 | BCBS (01) | TX |
B21422 | (02) | TX |