Provider Demographics
NPI:1275825002
Name:BORMAN, DANIEL JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JACOB
Last Name:BORMAN
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 1:9 WALDEN RIDGE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8592
Mailing Address - Country:US
Mailing Address - Phone:833-365-7246
Mailing Address - Fax:
Practice Address - Street 1:155 W MILLS ST STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-9462
Practice Address - Country:US
Practice Address - Phone:833-365-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9466207L00000X
FLME124453207LA0401X, 207LP2900X, 208VP0014X
NC202202501207LP2900X
SC88151207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine