MEDICARE: DR. THEODORE PORITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME 84245	FL

General Provider Information

NPI Number	:	1174748479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE PORITZ M.D.

Provider Business Mailing Address
First Line	:	6086 WILDCAT RUN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-3005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6086 WILDCAT RUN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-3005
Country	:	US
Telephone Number	:	561-624-3980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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