Individual
DOUGLAS RENE BOURGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 STANYAN ST, SAN FRANCISCO, CA 94117-1019
(415) 750-5687
Mailing address
FILE 1687, 1801 W OLYMPIC BLVD, PASADENA, CA 91199-1687
(415) 750-5687
(415) 683-5591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
985247
CA
2085R0202X
Diagnostic Radiology Physician
Primary
A85247
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A852470
—
CA
01
—
P00248458
RAILROAD MEDICARE PIN
—
Enumeration date
05/08/2006
Last updated
07/09/2015
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