Basic Information
| Provider Information | |||||||||
| NPI: | 1659688489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANIEL R. BOURQUE, M.D., A.P.M.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | BOURQUE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3372343344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 016161 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.