Provider Demographics
NPI:1205411642
Name:PORIS PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:PORIS PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-558-1616
Mailing Address - Street 1:324 E PAR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4004
Mailing Address - Country:US
Mailing Address - Phone:321-446-2509
Mailing Address - Fax:508-923-9894
Practice Address - Street 1:324 E PAR ST STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4004
Practice Address - Country:US
Practice Address - Phone:321-446-2509
Practice Address - Fax:508-923-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty