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Individual
CARLA INEZ BOURNE
Active
Individual
CARLA INEZ BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME107148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002245800
—
FL
01
—
149KG
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/05/2007
Last updated
01/07/2015
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