Individual
TIFFANY MOORE BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8212 SUMMA AVE, BATON ROUGE, LA 70809-3421
(225) 769-4403
(225) 769-3842
Mailing address
2012 POINTE SOUTH DR, ZACHARY, LA 70791-5426
(225) 202-0946
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2011-00769
NC
207L00000X
Anesthesiology Physician
Primary
MD.202681
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000892
—
LA
Enumeration date
07/31/2007
Last updated
10/23/2012
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