Provider Demographics
NPI:1487647988
Name:BORLAND, THOMAS AARON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:AARON
Last Name:BORLAND
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 1:2312 E MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4064
Mailing Address - Country:US
Mailing Address - Phone:337-364-0809
Mailing Address - Fax:337-364-0895
Practice Address - Street 1:2312 E MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4064
Practice Address - Country:US
Practice Address - Phone:337-364-0809
Practice Address - Fax:337-364-0895
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319481Medicaid
LA1319481Medicaid
LA50375Medicare ID - Type Unspecified