Lee Mason Bourdeau, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00013784 Issued in WA

Practice address

7440 Pacific Ave
Tacoma, WA 98408-7117

Phone

(253) 475-0511

Fax

(253) 475-7440

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1467483628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7440 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984087117",
            "telephone_number": "253-475-0511",
            "fax_number": "253-475-7440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7440 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984087117",
            "telephone_number": "253-475-0511",
            "fax_number": "253-475-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDEAU",
        "first_name": "LEE",
        "middle_name": "MASON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00013784",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00013784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8168650",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Kay Bougie
• Jerome Bouie, RN,BSN.CCRN
• Grace Bouker, MSOT
• Thomas Boulding, PA-C
• Jess W Bouma, MD
• Kenneth Stephen Bourque, CDPT
• Tricia Boushack, BCBA
• Phillip M Bouterse, MD
• Donald Alan Boutry, MD
• David Karl Bowden

• Family Medicine Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.