Provider Demographics
NPI:1063422830
Name:BOURGEOIS, FRANCIS JOHN (MD)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:JOHN
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2149
Mailing Address - Country:US
Mailing Address - Phone:540-351-0662
Mailing Address - Fax:540-351-0664
Practice Address - Street 1:75 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2149
Practice Address - Country:US
Practice Address - Phone:540-351-0662
Practice Address - Fax:540-351-0664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032325207V00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010059275Medicaid
C09045Medicare PIN
VA010059275Medicaid