Provider Demographics
NPI:1720067598
Name:BOREN, ERIC JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JASON
Last Name:BOREN
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 1:2121 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3704
Mailing Address - Country:US
Mailing Address - Phone:661-327-9693
Mailing Address - Fax:661-327-0749
Practice Address - Street 1:2121 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3704
Practice Address - Country:US
Practice Address - Phone:661-327-9693
Practice Address - Fax:661-327-0749
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77407207K00000X
CAA774070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA774070Medicaid
CAA774070Medicare ID - Type Unspecified
H89722Medicare UPIN