Active NPI
Barry Stephen Bordenave, M.D.
- Pediatric Adolescent Medicine Physician
- Lake Charles, LA
National Provider Identifier
1811017882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 13559
- Practice address
- 321 Overhill Dr
Lake Charles, LA 70605-6527 - Phone
- (337) 474-8886
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 13559 | LA | Primary |
Addresses
Primary practice location
321 Overhill Dr
Lake Charles, LA 70605-6527
Mailing address
321 Overhill Dr
Lake Charles, LA 70605-6527
Phone (337) 474-8886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13559 | LA | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811017882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 OVERHILL DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706056527",
"telephone_number": "337-474-8886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 OVERHILL DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706056527",
"telephone_number": "337-474-8886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDENAVE",
"first_name": "BARRY",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "LA",
"license": "13559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.