Provider Demographics
NPI:1275639759
Name:BORTON, MARC EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWIN
Last Name:BORTON
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 1:24 NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-3541
Mailing Address - Country:US
Mailing Address - Phone:479-253-7400
Mailing Address - Fax:
Practice Address - Street 1:24 NORRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3541
Practice Address - Country:US
Practice Address - Phone:479-253-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6484207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP01071362OtherRAILROAD MCARE
AR183139001Medicaid
ARP01166539OtherRAILROAD MCARE
AR260591YH95Medicare PIN
ARP01071362OtherRAILROAD MCARE