Individual
DIANE G PORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-6853
(813) 745-3906
Mailing address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-6853
(813) 745-3906
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME91579
FL
207LH0002X
Hospice and Palliative Medicine (Anesthesiology) Physician
Primary
ME91579
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28589
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/30/2006
Last updated
04/06/2012
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