Provider Demographics
NPI:1578505822
Name:BOREN, CAROL B (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:BOREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:109 SOUTHPARK DRIVE
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0610
Mailing Address - Country:US
Mailing Address - Phone:325-646-9956
Mailing Address - Fax:325-641-1010
Practice Address - Street 1:109 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5917
Practice Address - Country:US
Practice Address - Phone:325-646-9956
Practice Address - Fax:325-641-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK2310OtherMEDICAL LICENSE
TX81520NMedicare ID - Type Unspecified
TXG84920Medicare UPIN