Provider Demographics
NPI:1285016048
Name:PORTZ, BRENT JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:PORTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1215 LEE STREET - BOX NUMBER 800133
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0001
Mailing Address - Country:US
Mailing Address - Phone:434-924-8661
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST # 800133
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-2922
Practice Address - Country:US
Practice Address - Phone:434-924-8661
Practice Address - Fax:434-773-6803
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116028595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine