Individual
DR. LARRY AVIS BOURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12230 LIONESS WAY, PARKER, CO 80134-5603
(720) 644-9355
Mailing address
9250 E COSTILLA AVE STE 540, GREENWOOD VILLAGE, CO 80112-3648
(720) 644-9355
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
39560
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013365
KAISER COMMERCIAL NUMBER
CO
05
—
93909365
—
CO
Enumeration date
02/15/2006
Last updated
08/08/2023
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