Provider Demographics
NPI:1063406668
Name:BORJESON, CAREN LYNN (DO)
Entity type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:LYNN
Last Name:BORJESON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20033 N 19TH AVE
Mailing Address - Street 2:BLDG 3 SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4245
Mailing Address - Country:US
Mailing Address - Phone:602-439-1111
Mailing Address - Fax:623-582-2456
Practice Address - Street 1:20033 N 19TH AVE
Practice Address - Street 2:BLDG 3 SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4245
Practice Address - Country:US
Practice Address - Phone:602-439-1111
Practice Address - Fax:623-582-2456
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3117208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31758Medicare UPIN
WCKJS03Medicare ID - Type Unspecified