Individual
MR. EARL DOUGLAS BOURGOYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSCPO
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 256-2756
Mailing address
617 RIO HONDO RD NE, RIO RANCHO, NM 87144-4717
(505) 891-9210
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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