| Doctor Name: | MR. BARRY LAWRENCE BORDONARO |
| NPI Number: | 1982997839 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD.018171 |
| Business Practice Address: | 4336 North Blvd Suite 103 Baton Rouge, LA - 708063920 |
| Business Phone Number: | 2253793519 |
| Business Fax Number: | 2253793522 |
| Mailing Address: | 4336 North Blvd, Suite 103 BATON ROUGE |
| State: | LA |
| Postal Code: | 708063920 |
| Phone Number: | 2253793519 |
| Fax Number: | 2253793522 |
| NPI Enumeration Date: | 05/25/2011 |
| NPI Last Update Date: | 05/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD.018171 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |