Individual
JOHN PORTEOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Mailing address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C2981
CA
2086S0127X
Trauma Surgery Physician
C2981
CA
2086S0129X
Vascular Surgery Physician
C2981
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
C2981
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020013716
RAILROAD MEDICARE
CA
01
—
CD069A
MEDICARE GROUP PTAN
CA
01
—
CF369Z
MEDICARE INDIVIDUAL PTAN
CA
01
—
ZZZ48224Z
MEDICARE IDENTIFICATION #
CA
Enumeration date
10/12/2005
Last updated
03/29/2011
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