Individual
DAN BORELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1532 W 32ND ST STE 301, JOPLIN, MO 64804-1607
(417) 347-2525
(417) 347-8991
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 347-2525
(417) 347-8991
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
R7509
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100143460B
—
KS
05
—
100198750A
—
OK
01
—
160052702
RR MEDICARE
—
05
—
200113207
—
MO
01
—
6058
ANTHEM
MO
Enumeration date
06/25/2006
Last updated
01/26/2009
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