Provider Demographics
NPI:1568788966
Name:PORTNOFF, RONALD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:PORTNOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:77714 COVE POINTE
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-6101
Mailing Address - Country:US
Mailing Address - Phone:760-772-6169
Mailing Address - Fax:760-772-6189
Practice Address - Street 1:77714 COVE POINTE
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-6101
Practice Address - Country:US
Practice Address - Phone:760-772-6169
Practice Address - Fax:760-772-6189
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC31418207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery