Individual
BRUCE A BOURDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 SKYLYN DR, SPARTANBURG, SC 29307-1041
(864) 297-6574
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19592
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57-1074902
BCBS/SC
SC
01
—
930071137
MEDICARE RAILROAD
SC
05
—
T34022
—
SC
Enumeration date
05/25/2006
Last updated
05/28/2008
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