Individual
JERRY E BOUQUOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6516 MD ANDERSON BLVD, RM #3.094F, HOUSTON, TX 77030
(866) 446-4936
(713) 450-3988
Mailing address
6516 MD ANDERSON BLVD, RM #3.094F, HOUSTON, TX 77030
(866) 446-4936
(713) 450-3988
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
22003
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89D241
BLUE CROSS BLUE SHIELD
TX
01
—
P00305690
MEDICARE RAILROAD CARRIER
—
Enumeration date
02/15/2007
Last updated
07/08/2007
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