Provider Demographics
NPI:1275818056
Name:BORER, BRANDON L (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
Last Name:BORER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 38TH ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-562-4700
Mailing Address - Fax:402-562-4701
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE 133
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-562-4700
Practice Address - Fax:402-562-4701
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000261A213ES0103X
NE347213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026188000Medicaid
NENA2117006Medicare UPIN