Provider Demographics
NPI:1538142641
Name:BORDEN, ROBERT C (PA C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:BORDEN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE B 114
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-633-5155
Mailing Address - Fax:251-633-5125
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B 114
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-5155
Practice Address - Fax:251-633-5125
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-456363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4645995OtherAETNA
FL59074070OtherBSAL
FLE7948ZMedicare ID - Type Unspecified
FL4645995OtherAETNA