Provider Demographics
NPI:1568758357
Name:BRYAN J. BORGFELD, MD, PA
Entity Type:Organization
Organization Name:BRYAN J. BORGFELD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORGFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-219-6800
Mailing Address - Street 1:4300 WINDSOR CENTRE TRL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1862
Mailing Address - Country:US
Mailing Address - Phone:972-219-6800
Mailing Address - Fax:972-219-0053
Practice Address - Street 1:4300 WINDSOR CENTRE TRL
Practice Address - Street 2:SUITE 400
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1862
Practice Address - Country:US
Practice Address - Phone:972-219-6800
Practice Address - Fax:972-219-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034399801Medicaid
TX00K57UMedicare PIN
TXF58494Medicare UPIN