Provider Demographics
NPI:1902983307
Name:BORTEN, MOISES MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:MORRIS
Last Name:BORTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:561-733-4400
Mailing Address - Fax:561-733-5004
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:BLDG A., SUITE 760
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-733-4400
Practice Address - Fax:561-733-5004
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60415208000000X
FLME33183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3038076Medicaid
MAAA3905OtherHARVARD PILGRIM HEALTH CA
MAJ07683OtherBLUE CROSS BLUE SHIELD
FL013208900Medicaid
MAD08933Medicare UPIN
MA3038076Medicaid