Provider Demographics
NPI:1790850139
Name:BORCICKY, DAVID JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:BORCICKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 AIRPORT BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1751
Mailing Address - Country:US
Mailing Address - Phone:251-476-3338
Mailing Address - Fax:251-473-4047
Practice Address - Street 1:2152 AIRPORT BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1751
Practice Address - Country:US
Practice Address - Phone:251-476-3338
Practice Address - Fax:251-473-4047
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL77213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051001937OtherBC
AL051556287Medicare PIN
T68868Medicare UPIN
AL051001937OtherBC