Individual
KIRK BOURGEOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME116850
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
PGY.1.LSUN-PATH
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009490900
—
FL
Enumeration date
03/04/2008
Last updated
10/07/2020
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