Provider Demographics
NPI:1124106364
Name:BORTON, LINDIE K (MD)
Entity type:Individual
Prefix:
First Name:LINDIE
Middle Name:K
Last Name:BORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3811 N GARDEN CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5007
Mailing Address - Country:US
Mailing Address - Phone:208-287-5525
Mailing Address - Fax:208-287-5530
Practice Address - Street 1:3811 N GARDEN CENTER WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5007
Practice Address - Country:US
Practice Address - Phone:208-287-5525
Practice Address - Fax:208-287-5530
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-6227207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM-6227OtherSTATE MED LICENSE
CAG-49757OtherSTATE MED LICENSE
CAG-49757OtherSTATE MED LICENSE
IDM-6227OtherSTATE MED LICENSE
IDM-6227OtherSTATE MED LICENSE
CAG-49757OtherSTATE MED LICENSE