Provider Demographics
NPI:1952395360
Name:BORGES, EDUARDO F (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:F
Last Name:BORGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8390
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-8390
Mailing Address - Country:US
Mailing Address - Phone:772-398-5339
Mailing Address - Fax:772-337-2666
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260642900Medicaid
FL10474BMedicare ID - Type Unspecified
FL260642900Medicaid