Provider Demographics
NPI:1558514026
Name:BORDON, JESSICA DAWN (DPM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:BORDON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:CERDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:794 GENERATIONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0058
Mailing Address - Country:US
Mailing Address - Phone:830-500-3034
Mailing Address - Fax:830-515-1712
Practice Address - Street 1:598 N UNION AVE STE 350
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4196
Practice Address - Country:US
Practice Address - Phone:830-500-3034
Practice Address - Fax:830-515-1712
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1955213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ434272Medicaid
TX8FC829OtherBCBS
TXPENDINGMedicaid
TXPENDINGMedicaid
AZ2130079Medicare PIN
AZ434272Medicaid