Provider Demographics
NPI:1811017882
Name:BORDENAVE, BARRY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:STEPHEN
Last Name:BORDENAVE
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 1:321 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6527
Mailing Address - Country:US
Mailing Address - Phone:337-474-8886
Mailing Address - Fax:
Practice Address - Street 1:321 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6527
Practice Address - Country:US
Practice Address - Phone:337-474-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA135592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine