| Doctor Name: | DR. JASON E. PORTNOF |
| NPI Number: | 1760613426 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD, MD |
| License Number: | 246010 |
| Business Practice Address: | 100 Se 15 Ave Ft. Lauderdale, FL - 333013908 |
| Business Phone Number: | 9549831899 |
| Business Fax Number: | 9543183215 |
| Mailing Address: | 100 Se 15 Ave, FT. LAUDERDALE |
| State: | FL |
| Postal Code: | 333013908 |
| Phone Number: | 9549831899 |
| Fax Number: | 9543183215 |
| NPI Enumeration Date: | 07/29/2009 |
| NPI Last Update Date: | 02/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 246010 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |