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Organization
IRENE M. BOURGAULT DO PC
Active
Organization
IRENE M. BOURGAULT DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRENE MARY BOURGAULT D.O. (OWNER)
(702) 648-6228
Entity
Organization
Contact information
Practice address
3150 N TENAYA WAY STE 660, LAS VEGAS, NV 89128-0460
(702) 648-6228
(702) 648-9868
Mailing address
3150 N TENAYA WAY STE 660, LAS VEGAS, NV 89128-0460
(702) 648-6228
(702) 648-9868
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
350
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V32709
MEDICARE GROUP
NV
01
—
V32710
MEDICARE
NV
01
—
V39744
MEDICARE
NV
Enumeration date
11/13/2007
Last updated
12/18/2007
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