Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME0045569 | FL |
Y | 208600000X | Surgeon | ME0045569 | FL |
NPI | 1013993500 |
---|---|
Provider Name | David Porudominsky |
First Address | Margate, FL 33063 |
Second Address | Margate, FL 33063-5737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002661 | NEIGHBORHOOD (01) | FL |
008272 | AVMED (01) | FL |
0163188 | GHI (01) | FL |
049740100 | (05) | FL |
61413 | BLUE CROSS BLUE SHIELD (01) | FL |
D65279 | (02) |