Provider Demographics
NPI:1275735367
Name:PORTU, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PORTU
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 1:950 MANATEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8219
Mailing Address - Country:US
Mailing Address - Phone:239-235-7908
Mailing Address - Fax:239-692-8999
Practice Address - Street 1:950 MANATEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-8219
Practice Address - Country:US
Practice Address - Phone:239-235-7908
Practice Address - Fax:239-692-8999
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002101000Medicaid
FL146JLOtherBCBS
FLCJ028VOtherMEDICARE
FLCJ028Medicare PIN