Provider Demographics
NPI:1932145273
Name:BOUSQUET, JOHN ALPHONSE III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALPHONSE
Last Name:BOUSQUET
Suffix:III
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 1:505 N HIGHWAY 77
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1128
Mailing Address - Country:US
Mailing Address - Phone:972-923-1686
Mailing Address - Fax:972-923-9268
Practice Address - Street 1:505 N HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:972-923-1686
Practice Address - Fax:972-923-9268
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144669-04Medicaid
TX8BR079OtherBCBS
TX114466905Medicaid
TN84Y716OtherBCBS
TXC13646Medicare UPIN
TX1144669-04Medicaid
TXP00687110Medicare PIN
TX8L5647Medicare PIN
TN84Y716OtherBCBS