Provider Demographics
NPI:1023039823
Name:BORDERS, REBECCA J (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BORDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 OYSTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDISTO ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29438-6837
Mailing Address - Country:US
Mailing Address - Phone:843-869-3111
Mailing Address - Fax:843-869-3344
Practice Address - Street 1:805 OYSTER PARK DR
Practice Address - Street 2:
Practice Address - City:EDISTO ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29438-6837
Practice Address - Country:US
Practice Address - Phone:843-869-3111
Practice Address - Fax:843-869-3344
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC001811Medicaid
SC001811Medicaid
SCE193740281Medicare PIN
SC0740030001Medicare NSC