Organization
IRENE M. BOURGAULT DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRENE MARY BOURGAULT D.O. (OWNER)
(702) 648-6228
Entity
Organization
Contact information
Practice address
3150 N TENAYA WAY STE 660, LAS VEGAS, NV 89128-0460
(702) 648-6228
(702) 648-9868
Mailing address
3150 N TENAYA WAY STE 660, LAS VEGAS, NV 89128-0460
(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
01
—
V32709
MEDICARE GROUP
NV
01
—
V32710
MEDICARE
NV
01
—
V39744
MEDICARE
NV
Enumeration date
11/13/2007
Last updated
12/18/2007
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