1841271962 NPI number — PAUL A LEBOURGEOIS MD

Table of content: PAUL A LEBOURGEOIS MD (NPI 1841271962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841271962 NPI number — PAUL A LEBOURGEOIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBOURGEOIS
Provider First Name:
PAUL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1841271962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 164106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-448-7100
Provider Business Mailing Address Fax Number:
512-416-6409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
SOUTH AUSTIN HOSPITAL PATHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-6903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-448-7100
Provider Business Practice Location Address Fax Number:
512-416-6409
Provider Enumeration Date:
11/07/2005

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: 207ZP0102X , with the licence number:  E5566 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80P645 . This is a "BCBS OF TEXAS" identifier . This identifiers is of the category "OTHER".




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