Provider Demographics
NPI:1518966571
Name:BORDEN, MIRIAM B (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:B
Last Name:BORDEN
Suffix:
Gender:F
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:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3093
Practice Address - Country:US
Practice Address - Phone:573-302-2828
Practice Address - Fax:573-302-2830
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015685207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00173681OtherRAILROAD MEDICARE
MO209210509Medicaid
I18844Medicare UPIN
MO209210509Medicaid