Renee A. Bourquard, MD
Surgery in Boise, ID. Individual provider (NPI-1).
NPI number1790737591
StatusActive
Last updated in NPPESJul 24, 2013
Details
- NPI
- 1790737591
- Entity type
- Individual (NPI-1)
- Name
- Renee A. Bourquard
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 17, 2006
- Last updated
- Jul 24, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | M5303 | ID | Yes |
Practice location
100 Warm Springs AveSte B
Boise, ID 83712-6243
Phone 208-381-6930 · Fax 208-381-6931
Mailing address
190 E Bannock StBoise, ID 83712-6241
Phone 208-381-2222
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