Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 18831 | KY |
NPI | 1013984624 |
---|---|
Provider Name | Ted Borodofsky |
First Address | Paducah, KY 42001-7105 |
Second Address | Paducah, KY 42001-7105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000044965 | ANTHEM BCBS (01) | |
0470669210 | (05) | IL |
64188311 | (05) | KY |
C72047 | (02) |