Organization
THAD A . BOURQUE, M.D. APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAD ALEXANDER BOURQUE M.D. (OWNER)
(337) 234-5554
Entity
Organization
Contact information
Practice address
913 S COLLEGE RD, SUITE 209, LAFAYETTE, LA 70503-3060
(337) 234-5554
Mailing address
913 S COLLEGE RD, SUITE 209, LAFAYETTE, LA 70503-3060
(337) 234-5554
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
021311
LA
Other
Enumeration date
10/17/2006
Last updated
07/26/2007
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