Provider Demographics
NPI:1962596635
Name:BORDES, JOHN H JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:BORDES
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 S IBERIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5530
Mailing Address - Country:US
Mailing Address - Phone:337-364-7436
Mailing Address - Fax:
Practice Address - Street 1:118 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4039
Practice Address - Country:US
Practice Address - Phone:337-898-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4147367500000X
LAAP02115367500000X
OK200222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKIJ2491OtherMEDICARE PIN
LA1667013Medicaid
FL001728000Medicaid
OK200941640AMedicaid
LAP00166165Medicare PIN