Provider Demographics
NPI:1063111227
Name:BORDELON, ANNE MEREDITH
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MEREDITH
Last Name:BORDELON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MEREDITH
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 TOWN CENTRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6188
Mailing Address - Country:US
Mailing Address - Phone:541-342-5088
Mailing Address - Fax:
Practice Address - Street 1:955 TOWN CENTRE DR STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6188
Practice Address - Country:US
Practice Address - Phone:541-342-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist