Provider Demographics
NPI:1063410991
Name:BORBELY, BERNARD R (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:R
Last Name:BORBELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 WHETSTONE PL
Mailing Address - Street 2:STE 210
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5775
Mailing Address - Country:US
Mailing Address - Phone:904-819-6800
Mailing Address - Fax:904-819-6700
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:SUITE208
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-819-6800
Practice Address - Fax:904-819-6700
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME82827207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG39179Medicare UPIN