Individual
BRYSON DALE BORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4357 THE MASTERS DR, FAIRFIELD, CA 94533-9514
(855) 292-1401
(866) 396-8340
Mailing address
23625 COMMERCE PARK, STE 204, BEACHWOOD, OH 44122-5845
(216) 255-5700
(216) 255-5701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35082726
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2601152
—
OH
05
—
7617030
—
NC
05
—
808272700
—
ID
05
—
Q11300
—
SC
Enumeration date
04/10/2006
Last updated
12/30/2011
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