Individual
THAD ALEXANDER BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
021311
LA
208800000X
Urology Physician
Primary
MD.021311
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1680974
—
LA
01
—
C5115
BLUE CROSS BLUE SHIELD
LA
Enumeration date
10/05/2006
Last updated
04/15/2026
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