Healthcare Provider Details

I. General information

NPI: 1255393492
Provider Name (Legal Business Name): JOHN STEVEN PORTWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR SUITE 2
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DR SUITE 2
RIVERSIDE CA
92503-4001
US

V. Phone/Fax

Practice location:
  • Phone: 951-354-7270
  • Fax: 951-354-0625
Mailing address:
  • Phone: 951-354-7270
  • Fax: 951-354-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberG51596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberG51596
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG51596
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG51596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: