Basic Information
| Provider Information | |||||||||
| NPI: | 1265649115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOURGEOIS | ||||||||
| FirstName: | SEBASTIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 ALLEN STREET | ||||||||
| Address2: | SPRINGFIELD ANESTHESIA SERVICE | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137967494 | ||||||||
| FaxNumber: | 4137967497 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 ALLEN STREET | ||||||||
| Address2: | SPRINGFIELD ANESTHESIA SERVICE | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137967494 | ||||||||
| FaxNumber: | 4137967497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 242564 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.