Individual
DAVID CLARKE BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2093 HENRY TECKLENBURG DR STE 200E, CHARLESTON, SC 29414-5742
(843) 958-2500
(843) 958-2680
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3492
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3492
SC LICENSE
SC
05
—
4170PA
—
SC
Enumeration date
08/09/2019
Last updated
02/26/2025
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