Individual
MR. DANIEL BORGSTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
255 W HERNDON AVE # 103, CLOVIS, CA 93612-0381
(559) 326-2999
Mailing address
PO BOX 28949, FRESNO, CA 93729-8949
(559) 228-4200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G53110
CA
207V00000X
Obstetrics & Gynecology Physician
G53110
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G531100
BLUE CROSS/BLUE SHIELD
CA
05
—
00G531100
—
CA
01
—
110121877
RAILROAD MEDICARE
CA
01
—
77040368493612B009
CHAMPUS
CA
Enumeration date
11/08/2005
Last updated
03/16/2021
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