Individual
ROBERT C BOURGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
9304
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010716
BLUE CROSS
AL
05
—
000010716
—
AL
01
—
00126738
MISSISSIPPI MEDICAID
MS
01
—
051512036
BLUE CROSS
AL
01
—
051512050
BLUE CROSS
AL
01
—
060002735
RAILROAD MEDICARE
AL
05
—
263918527A
—
GA
01
—
C71642
VIVA
AL
Enumeration date
05/27/2006
Last updated
06/29/2023
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