Provider Demographics
NPI:1649594714
Name:EDUARDO BORGES, MD, PA
Entity Type:Organization
Organization Name:EDUARDO BORGES, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-1313
Mailing Address - Street 1:1700 SE HILLMOOR DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7539
Mailing Address - Country:US
Mailing Address - Phone:772-335-1313
Mailing Address - Fax:772-335-1315
Practice Address - Street 1:1700 SE HILLMOOR DR
Practice Address - Street 2:SUITE 501
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7539
Practice Address - Country:US
Practice Address - Phone:772-335-1313
Practice Address - Fax:772-335-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260642900Medicaid
FLE70629Medicare UPIN
FL260642900Medicaid