THAD ALEXANDER BOURQUE (NPI# 1912093709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912093709 |
| Entity Type | Individual |
| Full Name | THAD ALEXANDER BOURQUE |
| Credential | M.D. |
| Practice Address |
1103 Kaliste Saloom Rd Suite 200 Lafayette LA 70508-5783 |
| Mailing Address |
120 Rue Louis Xiv Lafayette LA 70508-5783 |
| Practice Telephone | 3379881803 |
| Practice Fax Number | 3379881805 |
| Mailing Telephone | 3377697779 |
| Mailing Fax Number | 3377697800 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 021311 | LA | Other Service Providers |
| Y | 208800000X | Urology | MD.021311 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1680974 | 05 | |
| LA | DEA | BB3121198 | 01 |
| LA | BLUE CROSS BLUE SHIELD | C5115 | 01 |
| Street Address |
1103 KALISTE SALOOM RD SUITE 200 |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70508-5783 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215937073 | Daniel Lee Hodges | Physical Medicine & Rehabilitation | 1103 Kaliste Saloom Rd, Suite 100, Lafayette, LA 70508-5783 | 2005-07-22 |
| 1659827129 | William Brandon Barnhill | Registered Nurse | 1103 Kaliste Saloom Rd, Suite 304, Lafayette, LA 70508-5783 | 2016-08-25 |
| 1174980643 | Emily Degatur Hundley | Physician Assistant | 1103 Kaliste Saloom Rd, Suite 304, Lafayette, LA 70508-5783 | 2016-01-28 |
| 1962800656 | Laura Harolds | Nurse Practitioner | 1103 Kaliste Saloom Rd, Suite 202, Lafayette, LA 70508-5783 | 2014-12-11 |
| 1508265638 | Michael S Haydel Md Apmc | Anesthesiology | 1103 Kaliste Saloom Rd, Suite 202, Lafayette, LA 70508-5783 | 2014-08-14 |
| 1952716011 | Ashley Lynn Whitmore | Orthopaedic Surgery | 1103 Kaliste Saloom Rd, Ste. 100, Lafayette, LA 70508-5783 | 2014-06-27 |
| 1508277534 | Kimberly Taylor | Nurse Practitioner | 1103 Kaliste Saloom Rd, Suite 304, Lafayette, LA 70508-5783 | 2014-05-13 |
| 1245666254 | Emily Renee Thibodaux | Physician Assistant | 1103 Kaliste Saloom Rd, Suite 206, Lafayette, LA 70508-5783 | 2013-09-23 |
| 1851662795 | John B Sledge, IIi, Md,apmc | Orthopaedic Surgery | 1103 Kaliste Saloom Rd, Suite 100, Lafayette, LA 70508-5783 | 2012-01-24 |
| 1538438981 | Monique Therese Ardoin | Registered Nurse | 1103 Kaliste Saloom Rd, Suite 304, Lafayette, LA 70508-5783 | 2011-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868676 | Cypress Bend Oral & Maxillofacial Surgery | Dentist | 106 Rue Bastille, Lafayette, LA 70508 | 2020-07-13 |
| 1184250607 | Learning Grove Therapy LLC | Clinic/Center | 105 Anaheim Lane, Lafayette, LA 70508 | 2020-03-16 |
| 1780218727 | Jennifer Trumps | Case Manager/Care Coordinator | 200 Entergy Parkway, Lafayette, LA 70508 | 2020-02-28 |
| 1740749605 | Hunter Sy Arceneaux | Physical Therapist | 1700 Kaliste Saloom Road, Building 3, Suite 300, Lafayette, LA 70508 | 2019-03-19 |
| 1295292787 | Brad Michael Gros | Counselor | 160 South Beadle Road, Lafayette, LA 70508 | 2019-02-21 |
| 1205337581 | Alternative Perspectives, LLC | Clinic/Center | 2807 Kaliste Saloom Rd Ste B, Lafayette, LA 70508 | 2018-02-22 |
| 1124528807 | Zachariah James Hebert | Counselor | 1602 W Pinhook Rd Suite 100a, The Family Tree, Lafayette, LA 70508 | 2018-02-19 |
| 1164934477 | Ilyas Munshi, Md Apmc | Non-Pharmacy Dispensing Site | 99 W. Martial Ave, Lafayette, LA 70508 | 2017-10-26 |
| 1447761226 | Louisiana Orthopaedic Specialists, LLC | Durable Medical Equipment & Medical Supplies | 4231 Ambassador Caffery Pkwy, Suite 102, Lafayette, LA 70508 | 2017-10-19 |
| 1306365457 | Mk Dixon Counseling and Consulting | Counselor | 105 Industrial Parkway, Lafayette, LA 70508 | 2017-09-10 |
| Find all providers in zip 70508 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881012722 | Julio Tian-fa Chong | Urology | 300 Exempla Cir Ste 250, Lafayette, CO 80026-3392 | 2014-03-28 |
| 1093973984 | Charles Bruce Williams Jr. | Urology | 913 S College Rd Ste 203, Lafayette, LA 70503-3062 | 2008-05-28 |
| 1467540344 | Jeannette M Chassaignac | Urology | 1016 Coolidge Blvd, Lafayette, LA 70503-2436 | 2006-10-10 |
| 1275634107 | Jeffrey J Thibodeaux | Urology | 200-a Energy Parkway, Suite 209, Lafayette, LA 70508 | 2006-09-25 |
| 1851333520 | Emilia Ripoll | Urology | 120 Old Laramie Trail East, Lafayette, CO 80026-5600 | 2006-06-10 |
| 1548810120 | Advanced Urology, Pllc | Urology | 300 Exempla Cir Ste 250, Lafayette, CO 80026-3392 | 2019-09-16 |
| 1528420858 | Unity Healthcare, LLC | Urology | 1345 Unity Pl, Suite 110a, Lafayette, IN 47905-5760 | 2016-03-25 |
| 1750775672 | Hyosang Abraham Chiang | Urology | 280 Exempla Cir, Lafayette, CO 80026-3370 | 2015-03-28 |
| 1417369604 | Daniel B Abbott | Urology | 5177 Mccarty Ln, Lafayette, IN 47905-8764 | 2014-05-22 |
| 1760612865 | Southern Urology LLC | Urology | 1016 Coolidge Blvd, Lafayette, LA 70503-2436 | 2009-07-23 |
| Find all providers in LAFAYETTE | ||||
Please comment or provide details below to improve the information on THAD ALEXANDER BOURQUE.
| 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.