Individual
GLEB G BOURIANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 CLARKSVILLE ST, PARIS, TX 75460-6027
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D6955
TX
Other
Enumeration date
11/04/2006
Last updated
07/08/2007
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