MEDICARE: PAUL BORGESEN JR. MPAS, PA-C

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	363A00000X	Physician Assistant	2389	AZ

General Provider Information

NPI Number	:	1962594861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BORGESEN JR. MPAS, PA-C

Provider Business Mailing Address
First Line	:	13838 S 46TH PL
Second Line	:	SUITE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	480-961-0014
Fax Number	:	480-961-0024

Provider Business Practice Location Address
First Line	:	13838 S 46TH PL
Second Line	:	SUITE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	480-961-0014
Fax Number	:	480-961-0024

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/26/2008

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