Provider Demographics
NPI:1033267679
Name:BORDELON, JEFFREY H (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:BORDELON
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:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-609-2222
Mailing Address - Fax:501-321-9689
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6442
Practice Address - Country:US
Practice Address - Phone:501-609-2222
Practice Address - Fax:501-321-9689
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4139208M00000X
ARE-4139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154970001Medicaid
5N0126972OtherMEDICARE LINKED
ARG85337Medicare UPIN
AR5N012Medicare UPIN