Bourque, David Clarke

Bourque, David Clarke is an individual health care provider with primary practice located at 1483 Tobias Gadson Blvd Ste 202 , Charleston SC 29407-4796. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Bourque, David Clarke can be contacted via phone (843) 763-2320.

Contact Information

Primary practice address
1483 Tobias Gadson Blvd Ste 202 Charleston SC 29407-4796
Phone: (843) 763-2320
Fax: (843) 763-4198
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 3492 South Carolina

Profile Details

NPI number 1578118170
LBN Legal business name Bourque, David Clarke
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2019
Last updated Oct 28th, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578118170 NPPES
South Carolina Other 3492 SC LICENSE
South Carolina MEDICAID 4170PA SC LICENSE

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