Individual
MALLORY BOURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 701, BATON ROUGE, LA 70808-4300
(225) 765-5864
(225) 765-2013
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0006
(225) 765-9291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200789
LA
Other
Enumeration date
03/20/2015
Last updated
09/29/2023
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