Provider Demographics
NPI:1770575474
Name:BORST, MATTHEW P (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:BORST
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 1:1760 E RIVER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:2222 E HIGHLAND AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4880
Practice Address - Country:US
Practice Address - Phone:602-277-4868
Practice Address - Fax:602-230-9350
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-02-04
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
AZ20785207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110354Medicaid
AZ110354Medicaid
AZZMD20785Medicare ID - Type Unspecified
AZ121228Medicare PIN