Thad a . Bourque, M.D. Apmc

Primary specialty

SpecialistTaxonomy code 174400000X

License

021311 Issued in LA

Legal business name

THAD A . BOURQUE, M.D. APMC

Practice address

913 S College Rd
Suite 209
Lafayette, LA 70503-3060

Phone

(337) 234-5554

NPI assigned

Oct 17, 2006

Last updated

Jul 26, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thad Alexander Bourque, M.D.

Title

Owner

Phone

(337) 234-5554

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1598846891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 S COLLEGE RD",
            "address_2": "SUITE 209",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033060",
            "telephone_number": "337-234-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 S COLLEGE RD",
            "address_2": "SUITE 209",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033060",
            "telephone_number": "337-234-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAD A . BOURQUE, M.D. APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "BOURQUE",
        "authorized_official_first_name": "THAD",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-234-5554",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "021311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.