Provider Demographics
NPI:1992742589
Name:BORRERO, JAIME Q (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:Q
Last Name:BORRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8584
Mailing Address - Country:US
Mailing Address - Phone:318-443-7674
Mailing Address - Fax:318-443-4102
Practice Address - Street 1:211 N 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8584
Practice Address - Country:US
Practice Address - Phone:318-443-7674
Practice Address - Fax:318-443-4102
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD012168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50350Medicare ID - Type Unspecified