Basic Information
| Provider Information | |||||||||
| NPI: | 1770803769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORST | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706242403 | ||||||||
| FaxNumber: | 9704904173 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E BOULDER ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193646487 | ||||||||
| FaxNumber: | 7193646488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 07/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0102X | DR.0057547 | CO | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 390200000X | TL0005903 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | DR.0057547 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.