Provider Demographics
NPI:1649474628
Name:BORDON, ANTHONY S (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:BORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:FLOOR 6
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:730 N HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4132
Practice Address - Country:US
Practice Address - Phone:830-620-5393
Practice Address - Fax:830-620-5316
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8079208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01282389OtherRAILROAD MEDICARE
TX1G7341OtherMEDICARE
TX284898801Medicaid
TXP02587323OtherMEDICARE RAILROAD