DR. LARRY AVIS BOURG M.D. NPI 1205800182

NPI Information

NPI: 1205800182
Provider Name: DR. LARRY AVIS BOURG, M.D.
Classification: Specialist - 174400000X
Entity Type: Individual
Organization: SUMMIT MEDICAL CONSULTANTS PLLC

PECOS Registration: Yes

Address:
1055 CLERMONT ST
DENVER, CO
ZIP 80220
Phone: (303) 399-8020
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DR. Larry Avis Bourg, M.D. is a specialist in Denver, CO with 32 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Larry Avis Bourg, M.D. NPI is 1205800182. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Graduation Year:1992

The provider's business location address is:

1055 CLERMONT ST
DENVER, CO
ZIP 80220-808
Phone: (303) 399-8020
Fax: (303) 393-5128

The NPI 1205800182 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/15/2006 and was last updated on 6/25/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		39560	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C442458	MEDICARE PIN	COLORADO
2	CO307447	MEDICARE PIN	COLORADO
3	93909365	MEDICAID	COLORADO
4	013365	OTHER	COLORADO	KAISER COMMERCIAL NUMBER
5	F67870	MEDICARE UPIN	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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