Provider Demographics
NPI:1932638111
Name:PORTIN, ELIZABETH BRODSKY (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BRODSKY
Last Name:PORTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST STE 1710
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2616
Mailing Address - Country:US
Mailing Address - Phone:832-822-3658
Mailing Address - Fax:832-825-3689
Practice Address - Street 1:6701 FANNIN ST STE 1710
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2616
Practice Address - Country:US
Practice Address - Phone:832-822-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125070842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics