Healthcare Provider Details

I. General information

NPI: 1578568978
Provider Name (Legal Business Name): JOHN M BORMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 8TH AVE NW
ABERDEEN SD
57401-2365
US

IV. Provider business mailing address

310 8TH AVE NW
ABERDEEN SD
57401-2365
US

V. Phone/Fax

Practice location:
  • Phone: 605-226-2108
  • Fax: 605-229-7460
Mailing address:
  • Phone: 605-226-2108
  • Fax: 605-229-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7056
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3849
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: