Healthcare Provider Details

I. General information

NPI: 1326101254
Provider Name (Legal Business Name): BLAINE MCDERMOTT BORDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THOMAS RD STE 205
WEST MONROE LA
71291-5547
US

IV. Provider business mailing address

244 SAINT ANDREWS RD
CALHOUN LA
71225-7931
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-1900
  • Fax: 318-329-1901
Mailing address:
  • Phone: 318-396-1844
  • Fax: 318-396-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number018916
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: