Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | F5842 | TX |
NPI | 1457342842 |
---|---|
Provider Name | Michael Bourgeois |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79410-1805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100086010B | (05) | OK |
108958105 | FIRSTCARE COMMERCIAL (01) | TX |
138369704 | (05) | TX |
138369711 | (05) | TX |
36233 | (05) | NM |
36233 | PRESBYTERIAN COMMERCIAL (01) | NM |
460001727 | RAILROAD (01) | TX |
80822Z | HMO BLUE (01) | TX |
89C152 | BC/BS (01) | TX |
A119 | TRIWEST (01) | NM |
E33872 | (02) | TX |
V2944 | (05) | NM |