Doctor Name: | THOMAS BOURKE |
NPI Number: | 1922117902 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 29534 |
Business Practice Address: | 615 S New Ballas Rd Saint Louis, MO - 631418221 |
Business Phone Number: | 3142516031 |
Business Fax Number: | |
Mailing Address: | 555 N New Ballas Rd, Suite 150 SAINT LOUIS |
State: | MO |
Postal Code: | 631416825 |
Phone Number: | 3149918200 |
Fax Number: | 3149918206 |
NPI Enumeration Date: | 08/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29534 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |