Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G51596 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G51596 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G51596 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | G51596 | CA |
NPI | 1255393492 |
---|---|
Provider Name | Mr. John Steven Portwood |
First Address | Riverside, CA 92503-4001 |
Second Address | Riverside, CA 92503-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 02/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G546710 | (05) | CA |
E24856 | (02) | CA |