Provider Demographics
NPI:1700864014
Name:BORK, DAVID BURTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BURTON
Last Name:BORK
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-123262085R0202X
WAMD000173812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1700864014Medicaid
WA189513OtherL&I PROVIDER NUMBER
WA189514OtherL&I PROVIDER NUMBER
WA8195000Medicaid
WA189512OtherL&I PROVIDER NUMBER
WA8195000Medicaid
WAF01517Medicare UPIN
WA8195000Medicaid
WAG8851648Medicare PIN
WAG8897873Medicare PIN
ID1700864014Medicaid
WAG8857949Medicare PIN
WA8850541Medicare PIN
WA8850540Medicare PIN
WAP01142665OtherRAILROAD MEDICARE
WA189513OtherL&I PROVIDER NUMBER
WA189514OtherL&I PROVIDER NUMBER
WAG8924537Medicare PIN
WAP00189419Medicare PIN
P00368451Medicare PIN