Bourg, Larry Avis

Bourg, Larry Avis is an individual health care provider with primary practice located at 12230 Lioness Way , Parker CO 80134-5603. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bourg, Larry Avis can be contacted via phone (720) 644-9355.

Contact Information

Primary practice address
12230 Lioness Way Parker CO 80134-5603
Phone: (720) 644-9355
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 39560 Colorado

Profile Details

NPI number 1205800182
LBN Legal business name Bourg, Larry Avis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Aug 8th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205800182 NPPES
Colorado MEDICAID 93909365
Colorado Other 013365

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