Provider Demographics
NPI:1154502284
Name:PASCAL BORDY MD PA
Entity Type:Organization
Organization Name:PASCAL BORDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PASCAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BORDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-717-3092
Mailing Address - Street 1:530 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-2125
Mailing Address - Country:US
Mailing Address - Phone:941-391-5296
Mailing Address - Fax:941-375-8919
Practice Address - Street 1:530 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-2125
Practice Address - Country:US
Practice Address - Phone:941-391-5296
Practice Address - Fax:941-375-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty