Healthcare Provider Details

I. General information

NPI: 1265430235
Provider Name (Legal Business Name): ELLIOT HOWARD BORAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST STE 5A
MOBILE AL
36608-1753
US

IV. Provider business mailing address

PO BOX 160928
MOBILE AL
36616-1928
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5900
  • Fax: 251-342-3842
Mailing address:
  • Phone: 251-414-5900
  • Fax: 251-342-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number00007758
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: