Thad Alexander Bourque M.D.

NPI 1912093709 - Specialist - 174400000X

NPI Details
NPI 1912093709
Gender Male
Enumeration Date 10/05/2006
Last Updated 02/04/2011
Entity Type Individual
Active Over 10 years ago
Practice Location
1103 KALISTE SALOOM RD
SUITE 200
LAFAYETTE LA, 70508-5783, US
Phone (337) 988-1803
Fax (337) 988-1805
Business Location
120 RUE LOUIS XIV
LAFAYETTE LA, 70508-5783, US
Phone (337) 769-7779
Fax (337) 769-7800
Toxanomy
Taxonomy Code 174400000X
License State Louisiana
License Number 021311
Remove 1912093709 NPI Number
 

According to our database, Thad Alexander Bourque M.D. NPI is 1912093709, taxonomy code is 174400000X and license number is 021311, license state is located at Louisiana. Thad Alexander Bourque M.D. physically located at 1103 Kaliste Saloom Rd, Lafayette LA, 70508-5783. NPI Number Thad Alexander Bourque M.D. has the Individual type.

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1912093709 NPI number is provided on an as is basis without warranty of any kind. 1912093709 is maintained by the National Plan & Provider Enumeration System. The contents of Thad Alexander Bourque M.D. are for informational purposes only.