Individual
BRYAN CLARK BORDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
165 DARTMOUTH ST, INTERNAL MEDICINE, BOSTON, MA 02116-5123
(617) 859-5101
(617) 859-5050
Mailing address
165 DARTMOUTH ST, INTERNAL MEDICINE, BOSTON, MA 02116-5123
(617) 859-5101
(617) 859-5050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
231683
MA
207R00000X
Internal Medicine Physician
H62994
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2151383
—
MA
Enumeration date
04/27/2006
Last updated
10/23/2020
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