Provider Demographics
NPI:1235447491
Name:JEFFREY BOURNE D O MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JEFFREY BOURNE D O MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-391-3268
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-0148
Mailing Address - Country:US
Mailing Address - Phone:805-391-3268
Mailing Address - Fax:805-434-3209
Practice Address - Street 1:710 LAS CANOAS PL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2362
Practice Address - Country:US
Practice Address - Phone:805-391-3268
Practice Address - Fax:805-434-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty