Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | E0359 | TX |
NPI | 1073583423 |
---|---|
Provider Name | Benjamin Lee Portnoy |
First Address | Champions Gate, FL 33896-8310 |
Second Address | Houston, TX 77004-6937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 22/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097569001 | (05) | TX |
C20620 | (02) | TX |