MEDICARE: ALICIA BORDON MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	LL2149	TX

General Provider Information

NPI Number	:	1134315500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICIA BORDON MD, PA

Provider Business Mailing Address
First Line	:	746 COLUMBIA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-1635
Country	:	US
Telephone Number	:	713-880-5266
Fax Number	:	713-880-8515

Provider Business Practice Location Address
First Line	:	720 W 11TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6714
Country	:	US
Telephone Number	:	713-802-2565
Fax Number	:	713-880-8515

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALICIA RAQUEL BORDON
Credential	:	MD
Telephone Number	:	713-880-5266

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	08/05/2013

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