IndividualActive
Paul Bourque, CO
NPI 1669564779 · Specialist · Winter Park, FL
Provider details
- NPI number
- 1669564779
- Entity type
- Individual
- Primary specialty
- SpecialistOther Service Providers
- Credential
- CO
- Sex
- Male
- Sole proprietor
- No
- License
- ORT6 (FL)
Specialties & taxonomies
Other Service Providers
Practice location
1222 Orange Ave
Ste B
Winter Park, FL 32789-4918
Phone: (407) 740-7772
Fax: (407) 539-1791
Approximate (ZIP-level) locationGet directions
Mailing address
2704 Stone Ave
Deland, FL 32720-3803
Registry dates
- Enumerated
- 2006-09-28
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.