Provider Demographics
NPI:1871585901
Name:BOURGEOIS, MICHAEL CHARLES (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31003 SHERRIE LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-5793
Mailing Address - Country:US
Mailing Address - Phone:281-460-3120
Mailing Address - Fax:281-259-0879
Practice Address - Street 1:31003 SHERRIE LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-5793
Practice Address - Country:US
Practice Address - Phone:281-460-3120
Practice Address - Fax:281-259-0879
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19119183500000X
LA009868L183500000X
TX501613367500000X
LARN051202367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No183500000XPharmacy Service ProvidersPharmacist