Provider Demographics
NPI:1356394019
Name:BORDERS, ROSA (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:BORDERS
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 1:320 W 10TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6302
Mailing Address - Country:US
Mailing Address - Phone:509-586-5897
Mailing Address - Fax:509-586-5897
Practice Address - Street 1:521 N YOUNG ST
Practice Address - Street 2:KGH MEDICAL MALL
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7806
Practice Address - Country:US
Practice Address - Phone:509-585-5222
Practice Address - Fax:509-585-5271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029107208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8409294Medicaid
WA8409294Medicaid
F39731Medicare UPIN