Provider Demographics
NPI:1265608301
Name:BOUQUET FAMILY MEDICINE
Entity type:Organization
Organization Name:BOUQUET FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUQUET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-841-9219
Mailing Address - Street 1:12919 STROH RANCH CT
Mailing Address - Street 2:UNIT G
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7707
Mailing Address - Country:US
Mailing Address - Phone:303-841-9219
Mailing Address - Fax:303-841-9240
Practice Address - Street 1:12919 STROH RANCH CT
Practice Address - Street 2:UNIT G
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7707
Practice Address - Country:US
Practice Address - Phone:303-841-9219
Practice Address - Fax:303-841-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO35599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty