Provider Demographics
NPI:1659561082
Name:ALAN J BORNE, M D, APMC
Entity Type:Organization
Organization Name:ALAN J BORNE, M D, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-222-9205
Mailing Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5740
Mailing Address - Country:US
Mailing Address - Phone:318-222-9205
Mailing Address - Fax:318-222-3625
Practice Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 440
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5740
Practice Address - Country:US
Practice Address - Phone:318-222-9205
Practice Address - Fax:318-222-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330701Medicaid
0400898OtherUNITED HEALTHCARE
4386850490OtherBLUE CROSS BLUE SHIELD
110043416OtherRAILROAD MEDICARE
TX074222301Medicaid
234735300OtherDEPARTMENT OF LABOR
LAB60408Medicare UPIN