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General NPI Number Information
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NPI Number | 1992731004
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Entity Type | Individual
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Provider Name | DONALD PORTELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 1555 INDIAN RIVER BLVD B-120
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City | VERO BEACH
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State | FL
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Zip | 32960-7103
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Country | US
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Telephone | 772-778-9621
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Fax | 772-778-3494
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Provider Business Mailing Address
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Address Line | PO BOX 918953
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City | ORLANDO
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State | FL
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Zip | 32891-8953
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS6625
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License Number State | FL
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