Individual
THAD ALEXANDER BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 RUE LOUIS XIV, BLDG 2, LAFAYETTE, LA 70508-5783
(337) 233-6665
(337) 534-0179
Mailing address
120 RUE LOUIS XIV, BLDG 2, LAFAYETTE, LA 70508-5783
(337) 233-6665
(337) 534-0179
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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