Provider Demographics
NPI:1043275514
Name:BOURDON, JOANY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANY
Middle Name:
Last Name:BOURDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. ALT. PIEDRAS BLANCAS
Mailing Address - Street 2:7 RAMON MURGA STREET BOX 16
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9404
Mailing Address - Country:US
Mailing Address - Phone:787-960-4561
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLO
Practice Address - Street 2:CARRETERA # 22 PASEO DR. JOSE C. BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine