Healthcare Provider Details

I. General information

NPI: 1396034468
Provider Name (Legal Business Name): BRUCE PETER BORDLEE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

522 JOSEPH ST
NEW ORLEANS LA
70115-2040
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-7627
  • Fax: 504-988-7616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME125351
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.205464
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME125351
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD.205464
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: