MEDICARE: BENJAMIN LEE PORTNOY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	E0359	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073583423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN LEE PORTNOY MD

Provider Business Mailing Address
First Line	:	8390 CHAMPIONS GATE BLVD
Second Line	:	SUITE 215
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8310
Country	:	US
Telephone Number	:	407-390-1677
Fax Number	:	407-390-1765

Provider Business Practice Location Address
First Line	:	1200 BINZ STREET
Second Line	:	SUITE 1290
City	:	HOUSTON
State	:	TX
Zip	:	77004-6937
Country	:	US
Telephone Number	:	713-524-8700
Fax Number	:	713-524-2910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/22/2016

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