Provider Demographics
NPI:1326101254
Name:BORDERS, BLAINE MCDERMOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:MCDERMOTT
Last Name:BORDERS
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 1:244 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-7931
Mailing Address - Country:US
Mailing Address - Phone:318-396-1844
Mailing Address - Fax:318-396-6163
Practice Address - Street 1:244 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:LA
Practice Address - Zip Code:71225-7931
Practice Address - Country:US
Practice Address - Phone:318-396-1844
Practice Address - Fax:318-396-6163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018916208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1915131Medicaid
LA1915131Medicaid
LAE89736Medicare UPIN