Active NPI
Lynn Bourdon, M.D.
- Family Medicine Physician
- Daingerfield, TX
National Provider Identifier
1376548180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C8905
- Practice address
- 200 W Scurry St Ste a
Daingerfield, TX 75638-1634 - Phone
- (903) 645-2044
- Fax
- (903) 645-2270
- NPI assigned
- Jun 17, 2005
- Last updated
- May 7, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C8905 | TX | Primary |
Addresses
Primary practice location
200 W Scurry St Ste a
Daingerfield, TX 75638-1634
Mailing address
1100 Mockingbird LN
Longview, TX 75601-3556
Phone (903) 236-3323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135593511 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longview Wellness Center Inc | Family Medicine | Past | Accepting new patients |
| GS Physician Services | Family Medicine | Past | Accepting new patients |
| Longview Wellness Center Inc | Family Medicine | Past | Accepting new patients |
| Phynet, Inc. | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Gladewater, TX
- NPI 1356399406
-
dba Wellness Pointe
- Federally Qualified Health Center (FQHC)
- Longview, TX
- NPI 1255137659
Family Medicine
-
dba Wellness Pointe
- Federally Qualified Health Center (FQHC)
- Longview, TX
- NPI 1578369922
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367884800000",
"number": "1376548180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 MOCKINGBIRD LN",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756013556",
"telephone_number": "903-236-3323",
"fax_number": "903-236-3734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W SCURRY ST STE A",
"city": "DAINGERFIELD",
"state": "TX",
"postal_code": "756381634",
"telephone_number": "903-645-2044",
"fax_number": "903-645-2270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURDON",
"first_name": "LYNN",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2013-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "C8905",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135593511",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daingerfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.