Healthcare Provider Details

I. General information

NPI: 1144273350
Provider Name (Legal Business Name): GEORGE CARL BORST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE 340
ASHLAND KY
41101-2879
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-9441
  • Fax: 606-326-0404
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21922
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: