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General NPI Number Information
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NPI Number | 1942688031
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Entity Type | Individual
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Provider Name | LEEOR ISRAEL PORGES D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 201 NW 82ND AVENUE S 501
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City | PLANTATION
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State | FL
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Zip | 33324
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Country | US
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Telephone | 954-473-6750
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Fax | 954-473-6750
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Provider Business Mailing Address
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Address Line | 201 NW 82ND AVENUE S 501
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City | PLANTATION
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State | FL
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Zip | 33324
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Country | US
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Telephone | 954-473-6750
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Fax | 954-424-9073
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS13856
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License Number State | FL
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