Provider Demographics
NPI:1194041426
Name:BORDE, PHILIP OFIMIANO JR (IDMT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:OFIMIANO
Last Name:BORDE
Suffix:JR
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 MESA RICO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7228
Mailing Address - Country:US
Mailing Address - Phone:940-337-1724
Mailing Address - Fax:
Practice Address - Street 1:4660 MESA RICO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7228
Practice Address - Country:US
Practice Address - Phone:940-337-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians