Provider Demographics
NPI:1285676163
Name:BOURGEOIS, RALPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JAMES
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 1:855 BELANGER ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4463
Mailing Address - Country:US
Mailing Address - Phone:985-581-0059
Mailing Address - Fax:985-851-0156
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-581-0059
Practice Address - Fax:985-851-0156
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018173207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1377368Medicaid
LA1377368Medicaid
LAC67112Medicare UPIN