Provider Demographics
NPI:1174578660
Name:BORRA, HENRY M (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:BORRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIDDEN WAY
Mailing Address - Street 2:APT. 6
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6072
Mailing Address - Country:US
Mailing Address - Phone:316-650-1805
Mailing Address - Fax:
Practice Address - Street 1:300 HIDDEN WAY
Practice Address - Street 2:APT. 6
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6072
Practice Address - Country:US
Practice Address - Phone:316-650-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24115207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25483Medicare UPIN