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Individual

DR. MARK D BORUP

Active
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Individual

DR. MARK D BORUP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M-6032
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010005929
REGENCE BLUE SHIELD
ID
01
DA152
BLUE CROSS OF IDAHO
ID
Enumeration date
10/03/2006
Last updated
07/08/2007
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