Provider Demographics
NPI:1962594861
Name:BORGESEN, PAUL JR (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BORGESEN
Suffix:JR
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 S 46TH PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7800
Mailing Address - Country:US
Mailing Address - Phone:480-961-0014
Mailing Address - Fax:480-961-0024
Practice Address - Street 1:13838 S 46TH PL
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7800
Practice Address - Country:US
Practice Address - Phone:480-961-0014
Practice Address - Fax:480-961-0024
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63641Medicare UPIN