Provider Demographics
NPI:1700040532
Name:LINDIE BORTON M.D. PA
Entity Type:Organization
Organization Name:LINDIE BORTON M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-287-5525
Mailing Address - Street 1:3811 N GARDEN CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5007
Mailing Address - Country:US
Mailing Address - Phone:208-287-5525
Mailing Address - Fax:208-287-5530
Practice Address - Street 1:3811 N GARDEN CENTER WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5007
Practice Address - Country:US
Practice Address - Phone:208-287-5525
Practice Address - Fax:208-287-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM62227207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA51454OtherUPIN
IDM6227OtherLICENSE
CAG49757OtherLICENSE
CAG49757OtherLICENSE
IDM6227OtherLICENSE