Individual
DR. BROCK M BORDELON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2222 N NEVADA AVE, SUITE 5017, COLORADO SPRINGS, CO 80907-6831
(719) 635-2501
(719) 632-1062
Mailing address
2222 N NEVADA AVE, SUITE 5017, COLORADO SPRINGS, CO 80907-6831
(719) 635-2501
(719) 632-1062
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33407
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01334077
—
CO
01
—
020027676
RAILROAD MEDICARE
—
01
—
4530815
AETNA PIN
—
01
—
BRD1868
COLORADO BLUE SHIELD
CO
Enumeration date
02/21/2006
Last updated
03/02/2018
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