Individual
DR. RAYMOND L. PORTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 N STATE ST, SUITE 480, JACKSON, MS 39202-2000
(601) 352-2273
(601) 714-3415
Mailing address
971 LAKELAND DR, STE 1052, JACKSON, MS 39216-4609
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
21256
MS
207RP1001X
Pulmonary Disease Physician
Primary
21256
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809533
—
MS
Enumeration date
07/06/2008
Last updated
02/05/2020
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