Provider Demographics
NPI:1669913943
Name:BOURGEOIS, DEVIN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHAEL
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 1:506 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4862
Mailing Address - Country:US
Mailing Address - Phone:985-493-4004
Mailing Address - Fax:985-493-4007
Practice Address - Street 1:506 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4862
Practice Address - Country:US
Practice Address - Phone:985-493-4004
Practice Address - Fax:985-493-4007
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine