Irene Mary Bourgault D.O.

NPI 1164562120 - Family Medicine - 207Q00000X

NPI Details
NPI 1164562120
Gender Female
Enumeration Date 02/07/2007
Last Updated 11/14/2012
Entity Type Individual
Active Over 9 years ago
Practice Location
3150 N TENAYA WAY
660
LAS VEGAS NV, 89128-0443, US
Phone (702) 648-6228
Fax (702) 648-9868
Business Location
3150 N TENAYA WAY
660
LAS VEGAS NV, 89128-0443, US
Phone (702) 648-6228
Fax (702) 648-9868
Toxanomy
Taxonomy Code 207Q00000X
License State Nevada
License Number 350
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According to our database, Dr. Irene Mary Bourgault D.O. NPI is 1164562120, taxonomy code is 207Q00000X and license number is 350, license state is located at Nevada. Irene Mary Bourgault D.O. physically located at 3150 N Tenaya Way, Las Vegas NV, 89128-0443. NPI Number Irene Mary Bourgault D.O. has the Individual type.

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1164562120 NPI number is provided on an as is basis without warranty of any kind. 1164562120 is maintained by the National Plan & Provider Enumeration System. The contents of Irene Mary Bourgault D.O. are for informational purposes only.