Individual
DANIEL R BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
435 HEYMANN BLVD, LAFAYETTE, LA 70503-2616
(337) 234-3344
(337) 234-3352
Mailing address
435 HEYMANN BLVD, LAFAYETTE, LA 70503-2616
(337) 234-3344
(337) 234-3352
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
016161
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1345580
—
LA
01
—
1659688489
GROUP NPI
LA
01
—
1952383084
INDIVIDUAL NPI
LA
01
—
5DQ00
GROUP PTAN
LA
01
—
5L938DQ00
INDIVIDUAL PTAN
LA
Enumeration date
08/16/2005
Last updated
06/20/2023
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