Provider Demographics
NPI:1083675730
Name:BORMES, PAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:BORMES
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:PO BOX 7025
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-7025
Mailing Address - Country:US
Mailing Address - Phone:888-877-3850
Mailing Address - Fax:631-329-6951
Practice Address - Street 1:350 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5423
Practice Address - Country:US
Practice Address - Phone:605-394-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3420207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84557Medicare UPIN
SDS7924Medicare PIN