Bordelon, Brock M
Bordelon, Brock M is an individual health care provider with primary practice located at 2222 N Nevada Ave Suite 5017, Colorado Springs CO 80907-6831. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Bordelon, Brock M can be contacted via phone (719) 635-2501.Contact Information
Primary practice address
2222 N Nevada Ave Suite 5017
Colorado Springs CO 80907-6831
Phone: (719) 635-2501
Fax: (719) 632-1062
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 33407 | Colorado |
Profile Details
| NPI number | 1447225669 |
|---|---|
| LBN Legal business name | Bordelon, Brock M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 21st, 2006 |
| Last updated | Mar 2nd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447225669 | NPPES |
| Colorado | MEDICAID | 01334077 | |
| Colorado | Other | 020027676 | |
| Colorado | Other | 4530815 | |
| Colorado | Other | BRD1868 |
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