Provider Demographics
NPI:1306088075
Name:BORCICH, ANTHONY MICHAEL (LMT, LMP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:BORCICH
Suffix:
Gender:M
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 NE GLISAN ST
Mailing Address - Street 2:FIRST FLOOR NORTH TOWER
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2933
Mailing Address - Country:US
Mailing Address - Phone:503-215-3219
Mailing Address - Fax:503-215-7572
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:FIRST FLOOR NORTH TOWER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-215-3219
Practice Address - Fax:503-215-7572
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11005174400000X
WAMA00019710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist