Bourque, Thad Alexander

Bourque, Thad Alexander is an individual health care provider with primary practice located at 1103 Kaliste Saloom Rd Suite 200, Lafayette LA 70508-5783. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Bourque, Thad Alexander can be contacted via phone (337) 988-1803.

Contact Information

Primary practice address
1103 Kaliste Saloom Rd Suite 200 Lafayette LA 70508-5783
Phone: (337) 988-1803
Fax: (337) 988-1805
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 021311 Louisiana
Allopathic & Osteopathic Physicians / Urology 208800000X MD.021311 Louisiana

Profile Details

NPI number 1912093709
LBN Legal business name Bourque, Thad Alexander
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 5th, 2006
Last updated Mar 7th, 2023 - about 3 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 1912093709 NPPES
Louisiana Other C5115 BLUE CROSS BLUE SHIELD
Louisiana MEDICAID 1680974 BLUE CROSS BLUE SHIELD

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