Individual
DOUGLAS A PORTELANCE
Active
Individual
DOUGLAS A PORTELANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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