1508779380 NPI number — JOAO BOURBON DE ALBUQUERQUE II MD

Table of content: JOAO BOURBON DE ALBUQUERQUE II MD (NPI 1508779380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508779380 NPI number — JOAO BOURBON DE ALBUQUERQUE II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOURBON DE ALBUQUERQUE
Provider First Name:
JOAO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508779380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MONSENHOR OLIVIO TEIXEIRA ST
Provider Second Line Business Mailing Address:
APARTMENT 501
Provider Business Mailing Address City Name:
ARACAJU
Provider Business Mailing Address State Name:
SE - SERGIPE
Provider Business Mailing Address Postal Code:
49026225
Provider Business Mailing Address Country Code:
BR
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2131 MINISTRO GERALDO BARRETO SOBRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ARACAJU
Provider Business Practice Location Address State Name:
SERGIPE
Provider Business Practice Location Address Postal Code:
4902010
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  2026046231 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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