Provider Demographics
NPI:1952399271
Name:PORTERFIELD, LEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:PORTERFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 COQUINA CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3004
Mailing Address - Country:US
Mailing Address - Phone:561-347-5656
Mailing Address - Fax:561-347-5656
Practice Address - Street 1:875 MEADOWS RD
Practice Address - Street 2:SUITE 331
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2349
Practice Address - Country:US
Practice Address - Phone:561-347-5656
Practice Address - Fax:561-347-5656
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35565174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00439656OtherRAILROAD MEDICARE
FL95453OtherBLUE CROSS BLUE SHIELD OF FLA
FLAD286OtherMEDICARE GROUP PIN
FL039345200Medicaid
FLP00439656OtherRAILROAD MEDICARE
FLD64797Medicare UPIN