Provider Demographics
NPI:1164645685
Name:KEITH A. BOURGEOIS, M.D., P.A.
Entity Type:Organization
Organization Name:KEITH A. BOURGEOIS, M.D., P.A.
Other - Org Name:DOWNTOWN EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-650-0931
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-650-0391
Mailing Address - Fax:713-650-0395
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1601
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-650-0391
Practice Address - Fax:713-650-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP085170J07Medicaid
TX85171JMedicare ID - Type UnspecifiedJOHN W. MILLER, M.D.
TX00023HMedicare ID - Type UnspecifiedGROUP NUMBER
TXP085170J07Medicaid
E08340Medicare UPIN
TX85170JMedicare ID - Type UnspecifiedKEITH A. BOURGEOIS, M.D.