Provider Demographics
NPI:1578502621
Name:BORG, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:BORG
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 1:3307 BARADA ST
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2470
Mailing Address - Country:US
Mailing Address - Phone:402-245-4475
Mailing Address - Fax:402-245-6651
Practice Address - Street 1:3307 BARADA ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2470
Practice Address - Country:US
Practice Address - Phone:402-245-4475
Practice Address - Fax:402-245-6651
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB68051Medicare UPIN
NE266411Medicare ID - Type Unspecified