Healthcare Provider Details

I. General information

NPI: 1790842623
Provider Name (Legal Business Name): BRIAN STEVEN PORTNOY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR SANFORD L. ZIFF BUILDING, 3RD FLOOR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR ASSEMBLY BUILDING II, SUITE 202
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4100
  • Fax: 954-262-2271
Mailing address:
  • Phone: 954-262-4346
  • Fax: 954-262-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS 6908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: