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NPI Code Detail

MEDICARE: DR. DANE M BORG PSY.D.

MEDICARE: DR. DANE M BORG PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TH0100XHealth Service Psychologist1578OR
2103T00000XPsychologist1578OR

General Provider Information

NPI Number : 1265558316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANE M BORG PSY.D.
Provider Business Mailing Address
First Line : 847 NE 19TH AVE STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 503-235-6256
Fax Number : 503-764-9646
Provider Business Practice Location Address
First Line : 847 NE 19TH AVE STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 503-235-6256
Fax Number : 503-764-9646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 06/21/2023

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