Healthcare Provider Details

I. General information

NPI: 1376518746
Provider Name (Legal Business Name): ERIC EUGENE BOROFSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S HIGHWAY 95 SUITE D
FORT MOHAVE AZ
86426-9251
US

IV. Provider business mailing address

5300 S HIGHWAY 95 SUITE D
FORT MOHAVE AZ
86426-9251
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-3609
  • Fax: 928-788-3607
Mailing address:
  • Phone: 928-788-3609
  • Fax: 928-788-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberEB042101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: