Active NPI
Renee A. Bourquard, MD
- Surgery Physician
- Boise, ID
National Provider Identifier
1790737591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M5303
- Practice address
- 100 Warm Springs Ave
Ste B
Boise, ID 83712-6243 - Phone
- (208) 381-6930
- Fax
- (208) 381-6931
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M5303 | ID | Primary |
Addresses
Primary practice location
100 Warm Springs Ave
Ste B
Boise, ID 83712-6243
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5303 | ID | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1790737591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241",
"telephone_number": "208-381-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WARM SPRINGS AVE",
"address_2": "STE B",
"city": "BOISE",
"state": "ID",
"postal_code": "837126243",
"telephone_number": "208-381-6930",
"fax_number": "208-381-6931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURQUARD",
"first_name": "RENEE",
"middle_name": "A.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M5303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.