Doctor Name: | DR. SCOTT A BORUCHOW |
NPI Number: | 1174772354 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 236439 |
Business Practice Address: | 12221 N Mopac Expy Austin, TX - 787582401 |
Business Phone Number: | 5129014011 |
Business Fax Number: | 5129013911 |
Mailing Address: | 12221 N Mopac Expy, AUSTIN |
State: | TX |
Postal Code: | 787582401 |
Phone Number: | 5129014011 |
Fax Number: | 5129013911 |
NPI Enumeration Date: | 09/12/2008 |
NPI Last Update Date: | 08/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 236439 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |