# DR. CYNTHIA L POORTENGA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1811991631
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD0000017131 | TN | Yes |

## Other

- **Enumeration date:** 06/09/2005
- **Last updated:** 02/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 246269 | ANTHEM BCBS VA | VA |
| 05 | — | 3372564 | — | TN |
| 01 | — | 4054392 | BCBS TN | TN |
| 01 | — | 5645956 | VA MEDICAID | VA |
| 01 | — | 830342546-01 | JOHN DEERE HEALTH INS | TN |