Provider Demographics
NPI:1477547370
Name:BORMANN, ALEX PETER (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:PETER
Last Name:BORMANN
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 1:4696 W OVERLAND RD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2845
Mailing Address - Country:US
Mailing Address - Phone:208-343-4383
Mailing Address - Fax:208-343-1482
Practice Address - Street 1:4696 W OVERLAND RD
Practice Address - Street 2:SUITE 228
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2845
Practice Address - Country:US
Practice Address - Phone:208-343-4383
Practice Address - Fax:208-343-1482
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL32472084P0800X
IDM-92352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry