Healthcare Provider Details

I. General information

NPI: 1649501180
Provider Name (Legal Business Name): ERNESTO PORRAS-POLO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 LINTON BLVD STE 301
DELRAY BEACH FL
33484-6539
US

IV. Provider business mailing address

5258 LINTON BLVD STE 301
DELRAY BEACH FL
33484-6539
US

V. Phone/Fax

Practice location:
  • Phone: 561-819-5496
  • Fax:
Mailing address:
  • Phone: 772-985-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME94761
License Number StateFL

VIII. Authorized Official

Name: ERNESTO F PORRAS-POLO
Title or Position: PRESIDENT
Credential: M.D
Phone: 772-464-0033