Provider Demographics
NPI:1730147000
Name:BOURKOVSKI, HEATHER (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOURKOVSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 PEREGRINE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-8794
Mailing Address - Country:US
Mailing Address - Phone:970-628-5840
Mailing Address - Fax:970-255-9641
Practice Address - Street 1:2525 N 8TH ST STE 202
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-245-1168
Practice Address - Fax:970-242-4299
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0371207V00000X
CO50461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010167598OtherRBS LAMERE
IDS6242OtherBCS LAMERE
ID312947OtherALTIUS
ID000010151852OtherREGENCE BLUE SHIELD
ID265447OtherALTIUS OLD
IDS5882OtherBLUE CROSS OLD
IDS6112OtherBLUE CROSS
COCOAAA3029Medicaid
ID11318461Medicare PIN
ID807268500Medicaid
ID000010167598OtherRBS LAMERE