GREG BOURDON (NPI# 1154365914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154365914 |
| Entity Type | Individual |
| Full Name | GREG BOURDON |
| Credential | P.A. |
| Practice Address |
500 W Broadway St Missoula MT 59802-4008 |
| Practice Telephone | 4063271827 |
| Practice Fax Number | 4063271697 |
| Mailing Telephone | 4063271827 |
| Mailing Fax Number | 4063271697 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2017-05-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 57553 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750424073 | Greg David Bourdon | Optometrist | 5001 Monroe St, Jcpenney Optical, Toledo, OH 43623-3627 | 2007-02-15 |
| Street Address |
500 W BROADWAY ST |
| City | MISSOULA |
| State | MT |
| Zip Code | 59802-4008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982600359 | Kendra B. Lee | Family Medicine | 500 W Broadway St, Missoula, MT 59802-4008 | 2005-06-21 |
| 1205468725 | Stephanie Elizabeth Carl | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-02-12 |
| 1942840483 | Credena Health LLC | Durable Medical Equipment & Medical Supplies | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-01-13 |
| 1346880119 | Kaylyn Casebolt Desrosier | Pharmacist | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-01-09 |
| 1689168049 | Kacia Bundle | Nurse Practitioner | 500 W Broadway St, Missoula, MT 59802-4008 | 2018-06-19 |
| 1114424488 | Hannah Gilliland | Nurse Practitioner | 500 W Broadway St, Missoula, MT 59802-4008 | 2018-04-12 |
| 1386164408 | Sandra Lynn Cummins | Social Worker | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-06-20 |
| 1548797152 | Joseph M Miller | Internal Medicine | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-05-12 |
| 1083147664 | Matthew Mcgady | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-04-10 |
| 1982135216 | Meeka Pradeep Gandhi | Pediatrics | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945921 | Montana Endoscopy Center, Pllc | Clinic/Center | 1930 W Broadway, Ste B, Missoula, MT 59802 | 2020-06-08 |
| 1194364091 | Tommie Lynn Perusich | Nurse Practitioner | 1120 Cedar St., Missoula, MT 59802 | 2019-12-26 |
| 1386122752 | The Hope Health Alliance, Inc. | Case Management | 314 White House Ln, Missoula, MT 59802 | 2018-07-30 |
| 1881181444 | Carol Anne Lesser | Massage Therapist | 1918 Birch St, Missoula, MT 59802 | 2018-04-19 |
| 1528587581 | Missoula Aids Fund, Inc. | Clinic/Center | 1500 W. Broadway Suite A, Missoula, MT 59802 | 2017-09-11 |
| 1942740667 | Gabrielle Shulman | Counselor | 415 N Higgins Ave Ste 14, Missoula, MT 59802 | 2017-02-28 |
| 1053798736 | Endurance Physio | Clinic/Center | 214 E. Main St, Missoula, MT 59802 | 2015-05-01 |
| 1720481971 | Anna Golding | Counselor | 1325 Wyoming Street, Missoula, MONTANA 59802 | 2014-10-02 |
| 1003255803 | Jennifer Dawn Danielson | Speech-Language Pathologist | 2408 Duncan Drive, Missoula, MT 59802 | 2013-06-14 |
| 1437595725 | Partnership Health Center Inc | Clinic/Center | 1150 Sherwood St, Missoula, MT 59802 | 2013-05-14 |
| Find all providers in zip 59802 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891269973 | Jason Enewold | Physician Assistant | 1424 Scott St, Missoula, MT 59802-2435 | 2019-01-11 |
| 1730664723 | Katrin Johanna Kahl | Physician Assistant | 5005 Pattee Canyon Rd, Missoula, MT 59803-1811 | 2018-09-26 |
| 1710230107 | Jennifer Culp | Physician Assistant | 900 N Orange St Ste 303, Missoula, MT 59802 | 2012-10-22 |
| 1629220488 | Richard Lee Wiesemann II | Physician Assistant | 1555 Liberty Ln Ste C, Missoula, MT 59808-2001 | 2008-10-10 |
| 1083710313 | Mindy Opper | Physician Assistant | 825 W. Kent St., Missoula, MT 59801-6619 | 2006-09-15 |
| 1689770919 | Kelly Polus | Physician Assistant | 610 N California St, Missoula, MT 59802-3950 | 2006-09-15 |
| 1447363916 | Mary C Velk | Physician Assistant | 2835 Fort Missoula Rd Ste 202, Missoula, MT 59804-7424 | 2006-08-17 |
| 1477592236 | Michael R Beckel | Physician Assistant | 900 N Orange St Ste 106, Missoula, MT 59802-2951 | 2006-06-06 |
| 1316933963 | Jenifer Darlene Caldwell | Physician Assistant | 1224 Lincoln Rd, Missoula, MT 59802-3041 | 2005-09-20 |
| 1841841590 | Jacklyn Joan Pfister | Physician Assistant | 1201 Wyoming St, Missoula, MT 59801-1727 | 2019-09-24 |
| Find all providers in MISSOULA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.