Provider Demographics
NPI:1427364587
Name:PORTNEY MED GROUP
Entity Type:Organization
Organization Name:PORTNEY MED GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-418-5916
Mailing Address - Street 1:5841 E CHARLESTON BLVD
Mailing Address - Street 2:SUITE 457
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 E CHARLESTON BLVD
Practice Address - Street 2:SUITE 457
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1021
Practice Address - Country:US
Practice Address - Phone:702-418-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty