Provider Demographics
NPI:1942688031
Name:PORGES, LEEOR ISRAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LEEOR
Middle Name:ISRAEL
Last Name:PORGES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 82ND AVENUE
Mailing Address - Street 2:S 501
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-473-6750
Mailing Address - Fax:954-424-9073
Practice Address - Street 1:201 NW 82ND AVENUE
Practice Address - Street 2:S 501
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-473-6750
Practice Address - Fax:954-473-6750
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13856207N00000X
FLUO3046390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program