Provider Demographics
NPI:1801931977
Name:GOURGUECHON, JEAN PAUL
Entity type:Individual
Prefix:MR
First Name:JEAN PAUL
Middle Name:
Last Name:GOURGUECHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3950
Mailing Address - Country:US
Mailing Address - Phone:406-721-1646
Mailing Address - Fax:406-543-9890
Practice Address - Street 1:610 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3950
Practice Address - Country:US
Practice Address - Phone:406-721-1646
Practice Address - Fax:406-543-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT132171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist