Provider Demographics
NPI:1710979075
Name:BORRESON, ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:BORRESON
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 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-393-4710
Mailing Address - Fax:504-394-5970
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-393-4710
Practice Address - Fax:504-394-5970
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10426R207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08037883Medicaid
LA1991767Medicaid
LA693855OtherAETNA
LA1991767Medicaid
LA693855OtherAETNA