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General NPI Number Information
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NPI Number | 1528078367
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Entity Type | Individual
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Provider Name | JOHN (JACK) KENNETH BORDERS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2000 ASHLAND DR
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City | ASHLAND
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State | KY
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Zip | 41101-7058
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Country | US
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Telephone | 606-326-0322
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Fax | 606-326-9809
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Provider Business Mailing Address
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Address Line | 2000 ASHLAND DR P.O. BOX 1447
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City | ASHLAND
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State | KY
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Zip | 41101-7058
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Country | US
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Telephone | 606-326-0322
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Fax | 606-326-9809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21774
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License Number State | KY
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