Provider Demographics
NPI:1942258991
Name:BOURGEOIS, JOHN ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELLIOT
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3121
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3121
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25883207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11125OtherWELLPATH
NC1533931002OtherCIGNA
NC6872OtherPARTNERS
NC0841480OtherUNITED HEALTHCARE
NC141004OtherCOVENTRY
NC4068491OtherAETNA
SC80783OtherCHCCARES OF SC
NC10482OtherKANAWHA
NC1963OtherDOCTORS HEALTH PLAN
NC376565OtherMAMSI
SC777013OtherWELLCARE
SC000000282479OtherUNISON HEALTH PLAN OF SC
NC1533931002OtherCIGNA PRIMEVISION
NC10610OtherBCBS MEDPOINT
SC20094032OtherSELECT HEALTH OF SC/FIRST CHOICE
SCN25883Medicaid
NC8917059Medicaid
NC100706OtherWELLNESS
NC21170OtherMEDCOST
NC17059OtherBCBS
180019848OtherRAILROAD MEDICARE
NC1533931002OtherCIGNA PRIMEVISION
SC80783OtherCHCCARES OF SC
2041915BMedicare PIN
NC10610OtherBCBS MEDPOINT