Provider Demographics
NPI:1407996762
Name:BORDERS, TRENT WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:WADE
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 1:205 HOSPITAL DRVIE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCKENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201
Mailing Address - Country:US
Mailing Address - Phone:731-352-7907
Mailing Address - Fax:731-352-4459
Practice Address - Street 1:205 HOSPITAL DRVIE
Practice Address - Street 2:SUITE A
Practice Address - City:MCKENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-7907
Practice Address - Fax:731-352-4459
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN417672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherMEDICARE GROUP
TN1511635Medicaid
TN3380640OtherMEDICAID GROUP
TN54583OtherAMERICAN BOARD OF RADIOLOGY CERTIFICATION
TN54583OtherAMERICAN BOARD OF RADIOLOGY CERTIFICATION