Provider Demographics
NPI:1689634289
Name:BORNFREUND, JONATHAN D (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:BORNFREUND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:106 LANSFORD CT.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-293-8850
Mailing Address - Fax:843-293-8860
Practice Address - Street 1:106 LANSFORD CT.
Practice Address - Street 2:SUITE 100
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588
Practice Address - Country:US
Practice Address - Phone:843-293-8850
Practice Address - Fax:843-293-8860
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC0708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC153867800OtherDEPARTMENT OF LABOR
SC193683OtherMEDCOST
SC7198502OtherCIGNA
SCP00057006OtherRAILROAD MEDICARE
SCH844238632Medicare PIN
SCP00057006OtherRAILROAD MEDICARE