Individual
BLAKE MICHAEL BOURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 NORTH BLVD STE 100, BATON ROUGE, LA 70806-3743
(225) 381-2621
(225) 387-7829
Mailing address
7373 PERKINS RD, BATON ROUGE, LA 70808-4373
(225) 246-9790
(225) 246-9160
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
328464
LA
Other
Enumeration date
03/21/2019
Last updated
06/22/2023
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