MEDICARE: DR. HENRY M BORRA M.D.

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	207L00000X	Anesthesiology Physician	04-24115	KS

General Provider Information

NPI Number	:	1174578660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY M BORRA M.D.

Provider Business Mailing Address
First Line	:	300 HIDDEN WAY
Second Line	:	APT. 6
City	:	SILVER CITY
State	:	NM
Zip	:	88061-6072
Country	:	US
Telephone Number	:	316-650-1805
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 HIDDEN WAY
Second Line	:	APT. 6
City	:	SILVER CITY
State	:	NM
Zip	:	88061-6072
Country	:	US
Telephone Number	:	316-650-1805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/11/2011

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