Healthcare Provider Details

I. General information

NPI: 1699820274
Provider Name (Legal Business Name): BERNARD M PORTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 BISHOP ST SUITE #1110
HONOLULU HI
96813-2807
US

IV. Provider business mailing address

8513 NE HAZEL DELL AVE SUITE #102
VANCOUVER WA
98665-8068
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-7300
  • Fax: 808-596-7305
Mailing address:
  • Phone: 800-594-8043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD-4132
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: