Healthcare Provider Details

I. General information

NPI: 1225442528
Provider Name (Legal Business Name): ALAN BORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 J ST
GRAND FORKS AFB ND
58205-6306
US

IV. Provider business mailing address

1599 J ST
GRAND FORKS AFB ND
58205-6306
US

V. Phone/Fax

Practice location:
  • Phone: 701-747-5544
  • Fax:
Mailing address:
  • Phone: 701-747-5544
  • Fax: 701-747-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29272
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: