Provider Demographics
NPI:1821156340
Name:BORDELON, PAULA C (DO)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:C
Last Name:BORDELON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:105 WILDWOOD DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633
Mailing Address - Country:US
Mailing Address - Phone:512-763-4060
Mailing Address - Fax:512-763-4088
Practice Address - Street 1:3149 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7209
Practice Address - Country:US
Practice Address - Phone:337-706-3415
Practice Address - Fax:337-706-3460
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012528207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108465Medicare PIN