Provider Demographics
NPI:1700881299
Name:BORNE, ALAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JOHN
Last Name:BORNE
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 1:1811 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5740
Mailing Address - Country:US
Mailing Address - Phone:318-222-9205
Mailing Address - Fax:318-222-3625
Practice Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 440
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5740
Practice Address - Country:US
Practice Address - Phone:318-222-9205
Practice Address - Fax:318-222-3625
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0400898OtherUNITED HEALTHCARE
TX074222301Medicaid
LA110043416OtherRAILROAD MEDICARE
LA1330701Medicaid
LA110043416OtherRAILROAD MEDICARE
LA1330701Medicaid
TX074222301Medicaid