Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | H1183 | TX |
Y | 2080P0210X | Pediatric Nephrologist | H1183 | TX |
NPI | 1013953017 |
---|---|
Provider Name | Ronald J Portman |
First Address | Houston, TX 77216-1088 |
Second Address | Houston, TX 77030-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88Y682 | BCBS (01) | TX |
C20617 | (02) | TX |