Provider Demographics
NPI:1578568978
Name:BORMES, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BORMES
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 1:310 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2365
Mailing Address - Country:US
Mailing Address - Phone:605-226-2108
Mailing Address - Fax:605-229-7460
Practice Address - Street 1:310 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2365
Practice Address - Country:US
Practice Address - Phone:605-226-2108
Practice Address - Fax:605-229-7460
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7056207W00000X
SD3849207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND180028582OtherRAILROAD MEDICARE
SD180028583OtherRAILROAD MEDICARE
ND18166Medicaid
SD6300130Medicaid
F86466Medicare UPIN
ND18166Medicaid
SDS3494Medicare PIN