Individual
DR. IRENE MARY BOURGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3150 N TENAYA WAY, 660, LAS VEGAS, NV 89128-0443
(702) 648-6228
(702) 648-9868
Mailing address
3150 N TENAYA WAY, 660, LAS VEGAS, NV 89128-0443
(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
05
—
002002873
—
NV
Enumeration date
02/07/2007
Last updated
11/14/2012
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