Provider Demographics
NPI:1073583423
Name:PORTNOY, BENJAMIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:1200 BINZ STREET
Practice Address - Street 2:SUITE 1290
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6937
Practice Address - Country:US
Practice Address - Phone:713-524-8700
Practice Address - Fax:713-524-2910
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE0359207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097569001Medicaid
TX097569001Medicaid
TXC20620Medicare UPIN