MEDICARE: DR. SETH PORTNOY D.O.

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	208D00000X	General Practice Physician	OS7518	FL
2	207Q00000X	Family Medicine Physician	OS7518	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS7518	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1225176209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH PORTNOY D.O.

Provider Business Mailing Address
First Line	:	9035 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6440
Country	:	US
Telephone Number	:	954-378-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	9035 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6440
Country	:	US
Telephone Number	:	954-378-0333
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	04/07/2023

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Directions to “ DR. SETH PORTNOY D.O.” Practice Location

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