Individual
LIZA P. BOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3500 W WHEATLAND RD, DALLAS, TX 75237-3460
(214) 947-7777
Mailing address
PO BOX 12740, WESTMINSTER, CA 92685-2740
(562) 809-3527
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M9925
TX
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
M9925
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196498301
—
TX
05
—
196498302
—
TX
01
—
8AN321
BCBSTX
TX
Enumeration date
08/31/2006
Last updated
01/20/2025
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