Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14706 | CO |
NPI | 1023145075 |
---|---|
Provider Name | Edward D Bordas Jr |
First Address | Aurora, CO 80014-1618 |
Second Address | Aurora, CO 80014-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012121 | KAISER-COMMERCIAL NUMBER (01) |