Provider Demographics
NPI:1477798957
Name:BOROFF, ROBERT DENNIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DENNIS
Last Name:BOROFF
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 1:20922 TUOLUMNE RD N
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9781
Mailing Address - Country:US
Mailing Address - Phone:209-928-4177
Mailing Address - Fax:
Practice Address - Street 1:20922 TUOLUMNE RD N
Practice Address - Street 2:
Practice Address - City:TUOLUMNE
Practice Address - State:CA
Practice Address - Zip Code:95379-9781
Practice Address - Country:US
Practice Address - Phone:209-928-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG028690OtherMEDICAL BOARD OF CALIFORNIA