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NPI Code Detail

MEDICARE: CINDY J PORTNER DO

MEDICARE: CINDY J PORTNER DO
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
1207L00000XAnesthesiology PhysicianH0052675MD
2207L00000XAnesthesiology Physician0102201838VA
3207L00000XAnesthesiology PhysicianOS20470FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1033579OTHERVAANTHEM
2484645OTHERVANCPPO
3K142-0001OTHERVACAREFIRST
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
531116OTHERVAAMERIGROUP

General Provider Information

NPI Number : 1629055447
Entity Type Code : Individual
Provider Name (Legal Business Name) : CINDY J PORTNER DO
Provider Business Mailing Address
First Line : PO BOX 945921
Second Line :
City : ATLANTA
State : GA
Zip : 30394-5921
Country : US
Telephone Number : 386-231-4529
Fax Number : 386-672-9904
Provider Business Practice Location Address
First Line : 301 MEMORIAL MEDICAL PKWY
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5167
Country : US
Telephone Number : 386-231-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 03/22/2024

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Directions to “ CINDY J PORTNER DO” Practice Location

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