Provider Demographics
NPI:1073922753
Name:BOURGUILLON, PEGGY (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BOURGUILLON
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:PO BOX 2474
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2474
Mailing Address - Country:US
Mailing Address - Phone:843-357-1299
Mailing Address - Fax:843-357-2264
Practice Address - Street 1:4959 HWY 17 BYPASS S.
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-357-1299
Practice Address - Fax:843-357-2264
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine