Provider Demographics
NPI:1699417055
Name:BOUSQUET, MADELEINE (MD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:BOUSQUET
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 1:7342 OAK MANOR DR APT 1207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4561
Mailing Address - Country:US
Mailing Address - Phone:210-844-3477
Mailing Address - Fax:
Practice Address - Street 1:7342 OAK MANOR DR APT 1207
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4561
Practice Address - Country:US
Practice Address - Phone:210-844-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program