Provider Demographics
NPI:1265430235
Name:BORAK, ELLIOT HOWARD (MD)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:HOWARD
Last Name:BORAK
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:PO BOX 160928
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36616-1928
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:251-342-3842
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:STE 5A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:251-342-3842
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007758207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932925Medicaid
AL2910053OtherUNITED HEALTHCARE
AL051517337OtherBCBS
AL051517337OtherBCBS
ALC73067Medicare UPIN