Healthcare Provider Details

I. General information

NPI: 1669519260
Provider Name (Legal Business Name): TIMOTHY RICHARD BORMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BELLEVUE ST SE SUITE 260
SALEM OR
97301-3819
US

IV. Provider business mailing address

700 BELLEVUE ST SE SUITE 260
SALEM OR
97301-3819
US

V. Phone/Fax

Practice location:
  • Phone: 503-375-3636
  • Fax: 503-375-3737
Mailing address:
  • Phone: 503-375-3636
  • Fax: 503-375-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberDO13782
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: