Healthcare Provider Details

I. General information

NPI: 1821156340
Provider Name (Legal Business Name): PAULA C BORDELON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-7209
US

IV. Provider business mailing address

105 WILDWOOD DRIVE SUITE 105
GEORGETOWN TX
78633
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-3415
  • Fax: 337-706-3460
Mailing address:
  • Phone: 512-763-4060
  • Fax: 512-763-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS012528
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: