MEDICARE: JOHN A. BORGOY 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	53595	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	53595	GA
3	208VP0014X	Interventional Pain Medicine Physician	MD28222	OR

General Provider Information

NPI Number	:	1255369617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. BORGOY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7530
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97303-0154
Country	:	US
Telephone Number	:	971-240-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 SKYLINE RD S
Second Line	:	KAISER PERMANENTE SKYLINE CLINIC
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:	503-566-4520
Fax Number	:	503-566-4557

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	02/04/2022

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