Provider Demographics
NPI:1902836455
Name:BORDELON, JAMES LYNN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LYNN
Last Name:BORDELON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4239 HIGHWAY 1192
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4771
Mailing Address - Country:US
Mailing Address - Phone:318-253-7767
Mailing Address - Fax:318-253-7756
Practice Address - Street 1:4239 HIGHWAY 1192
Practice Address - Street 2:SUITE 300
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4711
Practice Address - Country:US
Practice Address - Phone:318-253-7767
Practice Address - Fax:318-253-7756
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1525208600000X
LAMD.201214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1011959Medicaid
LA1011959Medicaid
LA4K665CY77Medicare PIN