Provider Demographics
NPI:1699820274
Name:PORTNER, BERNARD M (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:M
Last Name:PORTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 NE HAZEL DELL AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8068
Mailing Address - Country:US
Mailing Address - Phone:800-594-8043
Mailing Address - Fax:
Practice Address - Street 1:1132 BISHOP ST
Practice Address - Street 2:SUITE #1110
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2807
Practice Address - Country:US
Practice Address - Phone:808-596-7300
Practice Address - Fax:808-596-7305
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-41322081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000BDMFSMedicare ID - Type Unspecified