Doctor Name: | EDWARD A PORUBSKY |
NPI Number: | 1043286313 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 053019 |
Business Practice Address: | 340 N Belair Rd Evans, GA - 308093000 |
Business Phone Number: | 7068685676 |
Business Fax Number: | 7067222824 |
Mailing Address: | 340 N Belair Rd, EVANS |
State: | GA |
Postal Code: | 308093000 |
Phone Number: | 7068685676 |
Fax Number: | 7067222824 |
NPI Enumeration Date: | 02/27/2006 |
NPI Last Update Date: | 01/06/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207YS0123X |
License Number: | 053019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Otolaryngology |
Taxonomy Specialization: | Facial Plastic Surgery |
Taxonomy Definition: | An otolaryngologist who specializes in facial plastic surgery. |