Healthcare Provider Details

I. General information

NPI: 1427048776
Provider Name (Legal Business Name): DANIEL A BORDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

245 FOUNTAIN CT STE 225
LEXINGTON KY
40509-1888
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-9015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25687
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25687
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: