Basic Information
| Provider Information | |||||||||
| NPI: | 1295705408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTEE | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 W. GORE ST. | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496151 | ||||||||
| FaxNumber: | 4078436658 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 W GORE ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496151 | ||||||||
| FaxNumber: | 4078436658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME71051 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 252152100 | 05 | FL | MEDICAID |