Individual
ADAM LABREE BOURGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
633D MEDICAL GROUP, 77 NEALY AVE, JOINT BASE LANGLEY-EUSTIS, VA 23665-2040
(757) 764-6950
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0102205429
VA
208600000X
Surgery Physician
Primary
02004369A
IN
208600000X
Surgery Physician
74912
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2012
Last updated
01/26/2026
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