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General NPI Number Information
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NPI Number | 1770543894
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Entity Type | Individual
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Provider Name | PRODROMOS GORDON BORBOROGLU M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 575 S WICKHAM RD SUITE A
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1170
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Country | US
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Telephone | 321-308-5060
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Fax | 321-308-5069
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Provider Business Mailing Address
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Address Line | 2200 W EAU GALLIE BLVD SUITE 200
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City | MELBOURNE
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State | FL
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Zip | 32935-3165
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Country | US
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Telephone | 321-308-5060
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Fax | 321-308-5069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME99271
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License Number State | FL
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