Provider Demographics
NPI:1043386535
Name:BOURNE, MARGARET ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ELIZABETH
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11150 HIGHWAY ONE
Mailing Address - Street 2:BOX 240
Mailing Address - City:POINT REYES
Mailing Address - State:CA
Mailing Address - Zip Code:94956
Mailing Address - Country:US
Mailing Address - Phone:415-663-1082
Mailing Address - Fax:415-663-9474
Practice Address - Street 1:11150 HIGHWAY ONE
Practice Address - Street 2:
Practice Address - City:POINT REYES
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-1082
Practice Address - Fax:415-663-9474
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ2323082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A638360Medicaid
CAZZZ323682Medicare ID - Type Unspecified
CA00A638360Medicaid