Individual
MICHAEL BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4102 24TH ST STE 507, LUBBOCK, TX 79410-1805
(806) 743-7334
(806) 743-7332
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-2787
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
F5842
TX
208M00000X
Hospitalist Physician
F5842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100086010B
—
OK
01
—
108958105
FIRSTCARE COMMERCIAL
TX
05
—
138369704
—
TX
05
—
138369711
—
TX
01
—
36233
PRESBYTERIAN COMMERCIAL
NM
05
—
36233
—
NM
01
—
460001727
RAILROAD
TX
01
—
80822Z
HMO BLUE
TX
01
—
89C152
BC/BS
TX
01
—
A119
TRIWEST
NM
05
—
V2944
—
NM
Enumeration date
11/03/2005
Last updated
12/03/2021
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