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General NPI Number Information
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NPI Number | 1871505438
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Entity Type | Individual
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Provider Name | ROY BORS-KOEFOED M.D
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 6266 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-682-2595
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Fax | 901-682-2549
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Provider Business Mailing Address
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Address Line | 6266 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-682-2595
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Fax | 901-682-2549
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 35990
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License Number State | TN
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