Healthcare Provider Details

I. General information

NPI: 1841101961
Provider Name (Legal Business Name): COLT JOSHUA BORGESON CRM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

406 S RIVERSIDE AVE
MEDFORD OR
97501-7240
US

IV. Provider business mailing address

406 S RIVERSIDE AVE
MEDFORD OR
97501-7240
US

V. Phone/Fax

Practice location:
  • Phone: 541-621-2580
  • Fax:
Mailing address:
  • Phone: 541-621-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number26-CRM-5770
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: