Provider Demographics
NPI:1063462968
Name:BOURGEOIS, WARREN ROGER III (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:ROGER
Last Name:BOURGEOIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2931
Mailing Address - Country:US
Mailing Address - Phone:504-455-0093
Mailing Address - Fax:504-454-3964
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-455-0093
Practice Address - Fax:504-454-3964
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-03-10
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Provider Licenses
StateLicense IDTaxonomies
LA016725207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1931292Medicaid
LA1931292Medicaid
LA5N595Medicare ID - Type Unspecified