Provider Demographics
NPI:1427017292
Name:SKIN AND CANCER ASSOCIATES
Entity Type:Organization
Organization Name:SKIN AND CANCER ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-623-5595
Mailing Address - Street 1:261 N UNIVERSITY DR STE 720
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2009
Mailing Address - Country:US
Mailing Address - Phone:954-473-6750
Mailing Address - Fax:
Practice Address - Street 1:261 N UNIVERSITY DR STE 720
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2009
Practice Address - Country:US
Practice Address - Phone:954-473-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374016100Medicaid
FL39847Medicare ID - Type Unspecified
FL39847BMedicare ID - Type Unspecified
FL374016100Medicaid