Provider Demographics
NPI:1205831542
Name:BORLAND, FREDRICKA M (MD)
Entity type:Individual
Prefix:
First Name:FREDRICKA
Middle Name:M
Last Name:BORLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E SAVANNAH AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1241
Mailing Address - Country:US
Mailing Address - Phone:956-631-8155
Mailing Address - Fax:956-631-8187
Practice Address - Street 1:110 E SAVANNAH AVE
Practice Address - Street 2:BLDG A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1241
Practice Address - Country:US
Practice Address - Phone:956-631-8155
Practice Address - Fax:956-631-8187
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120120401Medicaid
TXOOCG40Medicare ID - Type Unspecified
TX120120401Medicaid