Bourquard, William Sullivan
Bourquard, William Sullivan is an sole proprietor health care provider with primary practice located at 6148 N Discovery Way Ste 100, Boise ID 83713-0201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Bourquard, William Sullivan can be contacted via phone (208) 322-5437.Contact Information
Primary practice address
6148 N Discovery Way Ste 100
Boise ID 83713-0201
Phone: (208) 322-5437
Fax: (208) 322-4638
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | M5223 | Idaho |
Profile Details
| NPI number | 1568451193 |
|---|---|
| LBN Legal business name | Bourquard, William Sullivan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 17th, 2005 |
| Last updated | May 19th, 2022 - about 2 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 | 1568451193 | NPPES |
| Idaho | MEDICAID | 003597000 | |
| Idaho | Other | 000010006127 | |
| Idaho | Other | 52233 |
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