Provider Demographics
NPI:1376518746
Name:BOROFSKY, ERIC EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
Last Name:BOROFSKY
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 1:5300 S HIGHWAY 95
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9251
Mailing Address - Country:US
Mailing Address - Phone:928-788-3609
Mailing Address - Fax:928-788-3607
Practice Address - Street 1:5300 S HIGHWAY 95
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-788-3609
Practice Address - Fax:928-788-3607
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEB042101207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1438577OtherAETNA
FL276061400Medicaid
FL4373307OtherAETNA
FL56539OtherBLUE CROSS BLUE SHIELD FL
FL0714609003OtherCIGNA
AZ425210Medicaid
FL366974OtherWELLCARE
FL1438577OtherAETNA
FL56539OtherBLUE CROSS BLUE SHIELD FL
FLB46096Medicare UPIN