Individual
MR. WILLIAM SULLIVAN BOURQUARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6148 N DISCOVERY WAY, STE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-4638
Mailing address
6148 N DISCOVERY WAY, STE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-4638
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M5223
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006127
BLUE SHIELD
ID
05
—
003597000
—
ID
01
—
52233
BLUE CROSS
ID
Enumeration date
10/17/2005
Last updated
05/19/2022
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