Borden, Evetta Lavern

Borden, Evetta Lavern is an individual health care provider with primary practice located at 510 E Stoner Ave , Shreveport LA 71101-4243. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as her primary health care specialty. Borden, Evetta Lavern can be contacted via phone (912) 977-0584.

Contact Information

Primary practice address
510 E Stoner Ave Shreveport LA 71101-4243
Phone: (912) 977-0584
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X POD000770 Georgia

Profile Details

NPI number 1215946702
LBN Legal business name Borden, Evetta Lavern
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 5th, 2006
Last updated Sep 1st, 2023 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215946702 NPPES
Georgia MEDICAID 00719804B

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