MEDICARE: DR. MANUEL PORTH 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	207X00000X	Orthopaedic Surgery Physician	0028637	FL
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	0028637	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639175532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL PORTH M.D.

Provider Business Mailing Address
First Line	:	7225 N UNIVERSITY DR
Second Line	:	STE 201
City	:	TAMARAC
State	:	FL
Zip	:	33321-2952
Country	:	US
Telephone Number	:	954-724-3400
Fax Number	:	954-724-9721

Provider Business Practice Location Address
First Line	:	7225 N UNIVERSITY DR
Second Line	:	STE 201
City	:	TAMARAC
State	:	FL
Zip	:	33321-2952
Country	:	US
Telephone Number	:	954-724-3400
Fax Number	:	954-724-9721

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/02/2016

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Directions to “ DR. MANUEL PORTH M.D.” Practice Location

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