Provider Demographics
NPI:1497949226
Name:NALE, BORU (MD)
Entity Type:Individual
Prefix:
First Name:BORU
Middle Name:
Last Name:NALE
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:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-0097
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:520-836-8807
Practice Address - Street 1:23 S MCNAB PKWY
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631
Practice Address - Country:US
Practice Address - Phone:520-385-2234
Practice Address - Fax:520-385-2113
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FQ031828OtherMEDICARE
AZFQ61788OtherMEDICARE
AZFQ61788OtherMEDICARE