Healthcare Provider Details

I. General information

NPI: 1326074584
Provider Name (Legal Business Name): BARRY PORTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KENDALL DR
LAMAR CO
81052-3939
US

IV. Provider business mailing address

201 KENDALL DR
LAMAR CO
81052-3939
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-0261
  • Fax: 719-336-0265
Mailing address:
  • Phone: 719-336-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: