MICHAEL BOURGEOIS (NPI# 1457342842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457342842 |
| Entity Type | Individual |
| Full Name | MICHAEL BOURGEOIS |
| Credential | M.D. |
| Practice Address |
4102 24th St Ste 507 Lubbock TX 79410-1805 |
| Mailing Address |
Po Box 5865 Lubbock TX 79408-5865 |
| Practice Telephone | 8067437334 |
| Practice Fax Number | 8067437332 |
| Mailing Telephone | 8067432898 |
| Mailing Fax Number | 8067432787 |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
F5842 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | FIRSTCARE COMMERCIAL | 108958105 | 01 |
| TX | 138369711 | 05 | |
| NM | V2944 | 05 | |
| OK | 100086010B | 05 | |
| TX | HMO BLUE | 80822Z | 01 |
| TX | 138369704 | 05 | |
| NM | 36233 | 05 | |
| TX | BC/BS | 89C152 | 01 |
| TX | RAILROAD | 460001727 | 01 |
| NM | PRESBYTERIAN COMMERCIAL | 36233 | 01 |
| NM | TRIWEST | A119 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3601 4th St, Lubbock, TX 794300002 | 8067437337 | 8067437329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740202555 | Michael O'donnell Bourgeois | Internal Medicine | Lsu Healthcare Network, 3401 North Blvd, Suite 400, Baton Rouge, LA 70806 | 2006-07-24 |
| 1871585901 | Michael Charles Bourgeois | Pharmacist | 31003 Sherrie Ln, Magnolia, TX 77354-5793 | 2005-08-16 |
| 1730641648 | Michael Jean Bourgeois | Student in an Organized Health Care Education/Training Program | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2019-04-01 |
| Street Address |
4102 24TH ST STE 507 |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851387393 | Surendra Varma | Pediatrics | 4102 24th St Ste 507, Lubbock, TX 79410-1805 | 2005-09-20 |
| 1851935365 | Jasmine Sanchez-ximenez | Nurse Practitioner | 4102 24th St Ste 507, Lubbock, TX 79410-1805 | 2019-10-29 |
| 1932611969 | Texas Tech University Health Sciences Center Lubbock | Durable Medical Equipment & Medical Supplies | 4102 24th St Ste 507, Lubbock, TX 79410-1805 | 2017-10-31 |
| 1124205513 | Nancy Louise Beck | Pediatrics | 4102 24th St Ste 507, Lubbock, TX 79410 | 2008-01-28 |
| 1518905934 | Adaobi Kanu | Pediatrics | 4102 24th St Ste 507, Lubbock, TX 79410 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851387393 | Surendra Varma | Pediatrics | 4102 24th St Ste 507, Lubbock, TX 79410-1805 | 2005-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073912325 | Pediatric Endocrinology Clinic | Pediatrics | 4302 S Sugar Rd Ste 205, Edinburg, TX 78539-9140 | 2014-08-21 |
| 1215292875 | Amrita Anil Waingankar | Pediatrics | 7711 O Connor Dr Apt 2502, Round Rock, TX 78681 | 2012-07-10 |
| 1447554860 | Pediatric Endocrinology of Central Texas Pllc | Pediatrics | 1605a Redwood Road, San Marcos, TX 78666-1424 | 2010-12-28 |
| 1164757712 | Virginia Cortes Araiza | Pediatrics | 3701 W Alabama St Ste 350, Houston, TX 77027-5264 | 2009-10-14 |
| 1992952758 | Jose David Gamez | Pediatrics | 2821 Michaelangelo Dr Ste 102a, Edinburg, TX 78539-1411 | 2008-08-24 |
| 1639356108 | Farah Mehdi Khatoon | Pediatrics | 8611 N Mopac Expy, Austin, TX 78759-8319 | 2008-01-28 |
| 1730378456 | Vandana S Raman | Pediatrics | 6621 Fannin St # Cc102005, Suite 1020, Houston, TX 77030-2303 | 2007-10-18 |
| 1154544054 | Amy M. Burton | Pediatrics | 6124 W Parker Rd Ste 230, Plano, TX 75093-8124 | 2007-04-10 |
| 1295870459 | Southwestern Diabetic Physicians Association | Pediatrics | 10687 Fm 678, Whitesboro, TX 76273-4840 | 2007-02-21 |
| 1881776367 | Otto Velasquez Md Phd & Associates | Pediatrics | 5111 N 10th St # 281, Mcallen, TX 78504-2835 | 2006-10-20 |
| Find all providers with the same taxonomy | ||||
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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.