Provider Demographics
NPI:1790842623
Name:PORTNOY, BRIAN STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STEVEN
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:ASSEMBLY BUILDING II, SUITE 202
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4346
Mailing Address - Fax:954-262-1172
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:SANFORD L. ZIFF BUILDING, 3RD FLOOR
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4100
Practice Address - Fax:954-262-2271
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 6908207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG03860Medicare UPIN
FL57151Medicare ID - Type UnspecifiedMEDICARE