Provider Demographics
NPI:1073749677
Name:BOURGEOIS, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8724
Mailing Address - Country:US
Mailing Address - Phone:205-621-9500
Mailing Address - Fax:205-621-9507
Practice Address - Street 1:1022 1ST ST N STE 201
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8724
Practice Address - Country:US
Practice Address - Phone:205-621-9500
Practice Address - Fax:205-621-9507
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD32223207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology