Healthcare Provider Details

I. General information

NPI: 1770575474
Provider Name (Legal Business Name): MATTHEW P BORST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date: 03/21/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

2222 E HIGHLAND AVE STE 400
PHOENIX AZ
85016-4880
US

IV. Provider business mailing address

1760 E RIVER RD STE 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4868
  • Fax: 602-230-9350
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number20785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: