Individual
DOUGLAS A PORTELANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12333 NE 130TH LN, STE 310, KIRKLAND, WA 98034
(425) 899-6700
(425) 899-6701
Mailing address
PO BOX 110456, MS 13739, TACOMA, WA 98411-0456
(425) 899-6700
(425) 899-6701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00024648
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0552PO
REGENCE HEALTH
WA
01
—
145685
LABOR & INDUSTRY
WA
Enumeration date
09/28/2006
Last updated
11/12/2012
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