Provider Demographics
NPI:1629280177
Name:BORDON, ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:BORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1635
Mailing Address - Country:US
Mailing Address - Phone:713-880-5266
Mailing Address - Fax:713-880-8515
Practice Address - Street 1:1631 NORTH LOOP W
Practice Address - Street 2:SUITE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1500
Practice Address - Country:US
Practice Address - Phone:713-880-5266
Practice Address - Fax:713-880-8515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine