Healthcare Provider Details

I. General information

NPI: 1215248695
Provider Name (Legal Business Name): CHRISTOFER D BORG CMD, RT(T)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

707 S SNOQUALMIE ST STE 2D
SEATTLE WA
98108-1740
US

V. Phone/Fax

Practice location:
  • Phone: 206-768-5356
  • Fax: 206-768-5331
Mailing address:
  • Phone: 206-368-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRT00004050
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License NumberRT00004050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: