Healthcare Provider Details

I. General information

NPI: 1245249929
Provider Name (Legal Business Name): LESTER STUART BORDEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ELAM AVE FL 2
GREENSBORO NC
27403-1157
US

IV. Provider business mailing address

509 N ELAM AVE FL 2
GREENSBORO NC
27403-1157
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-1114
  • Fax: 336-232-5325
Mailing address:
  • Phone: 336-274-1114
  • Fax: 336-232-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number200400642
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: