MEDICARE: MR. BARRY LAWRENCE BORDONARO 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	208D00000X	General Practice Physician	MD.018171	LA

General Provider Information

NPI Number	:	1982997839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY LAWRENCE BORDONARO M.D.

Provider Business Mailing Address
First Line	:	4336 NORTH BLVD
Second Line	:	SUITE 103
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-379-3519
Fax Number	:	225-379-3522

Provider Business Practice Location Address
First Line	:	4336 NORTH BLVD
Second Line	:	SUITE 103
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-379-3519
Fax Number	:	225-379-3522

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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