Healthcare Provider Details

I. General information

NPI: 1437379385
Provider Name (Legal Business Name): PORTLAND FAMILY MEDICINE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 LYTLE SHORES DR
ABILENE TX
79602-5206
US

IV. Provider business mailing address

1749 LYTLE SHORES DR
ABILENE TX
79602-5206
US

V. Phone/Fax

Practice location:
  • Phone: 210-643-9275
  • Fax:
Mailing address:
  • Phone: 210-643-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2900
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID PEREZ GILBERT
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 210-643-9275