Provider Demographics
NPI:1285824334
Name:BOURGEOIS, DANNY P JR (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:P
Last Name:BOURGEOIS
Suffix:JR
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 1:2335 CHURCH ST STE E
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-705-2489
Mailing Address - Fax:225-570-2986
Practice Address - Street 1:4801 MCHUGH RD
Practice Address - Street 2:SUITE H
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5364
Practice Address - Country:US
Practice Address - Phone:225-570-2489
Practice Address - Fax:225-570-2986
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4237208600000X
LAMD.203312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000582Medicaid
LA1000582Medicaid