MEDICARE: DR. ALEJANDRO BORREGO MD

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
1	174400000X	Specialist	BP1-0028129	TX
2	207QS0010X	Sports Medicine (Family Medicine) Physician	MD2010-0198	NM

General Provider Information

NPI Number	:	1770783391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEJANDRO BORREGO MD

Provider Business Mailing Address
First Line	:	2485 D HINMAN RD
Second Line	:
City	:	FPO
State	:	AA
Zip	:	79916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 D
Second Line	:
City	:	FT BLISS
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-742-7394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2007
Last Update Date	:	02/11/2016

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