Provider Demographics
NPI:1295706950
Name:BORGESON, DANA GEOFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:GEOFFREY
Last Name:BORGESON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3410 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1325
Mailing Address - Country:US
Mailing Address - Phone:715-344-1234
Mailing Address - Fax:715-344-6367
Practice Address - Street 1:3430 TAMIAMI TRL
Practice Address - Street 2:STE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8148
Practice Address - Country:US
Practice Address - Phone:855-674-4624
Practice Address - Fax:941-883-8368
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS59852085R0202X
OH34.0099432085R0202X
WI184132085R0202X
VA01020502012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology