Bourne, Russell A
Bourne, Russell A is an individual health care provider with primary practice located at 1025 Military Trl Suite 113, Jupiter FL 33458-7040. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bourne, Russell A can be contacted via phone (561) 748-2889.Contact Information
Primary practice address
1025 Military Trl Suite 113
Jupiter FL 33458-7040
Phone: (561) 748-2889
Fax: (561) 748-1523
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PY5579 | Florida |
Profile Details
| NPI number | 1134166762 |
|---|---|
| LBN Legal business name | Bourne, Russell A |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 1st, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134166762 | NPPES |
| Florida | Other | 54097 | BCBS |
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