Provider Demographics
NPI:1770543894
Name:BORBOROGLU, PRODROMOS GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:PRODROMOS
Middle Name:GORDON
Last Name:BORBOROGLU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3165
Mailing Address - Country:US
Mailing Address - Phone:321-308-5060
Mailing Address - Fax:321-308-5069
Practice Address - Street 1:575 S WICKHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1170
Practice Address - Country:US
Practice Address - Phone:321-308-5060
Practice Address - Fax:321-308-5069
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME99271208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00631812OtherRR MEDICARE
FL280092600Medicaid
FLAJ391ZMedicare PIN