Provider Demographics
NPI:1073563151
Name:BOURGON, PIERRE (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:BOURGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-689-5000
Mailing Address - Fax:239-689-5007
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-689-5000
Practice Address - Fax:239-689-5007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0046379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE12014Medicare UPIN