Healthcare Provider Details

I. General information

NPI: 1639527898
Provider Name (Legal Business Name): DAVID BORG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 29TH ST S
GREAT FALLS MT
59405-5353
US

IV. Provider business mailing address

1400 29TH ST S
GREAT FALLS MT
59405-5353
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax:
Mailing address:
  • Phone: 406-454-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-134650
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: