Provider Demographics
NPI:1184844649
Name:BORGLUND, JOHN R (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:BORGLUND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 KIRKWALL CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE 5020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6202
Practice Address - Fax:713-500-6201
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002433301Medicaid
TX87071UOtherBCBS
TX81062HOtherBCBS
TX8K5525Medicare PIN
TXR57263Medicare UPIN
TX002433301Medicaid
TX430072301Medicare PIN
TX81062HMedicare PIN