Provider Demographics
NPI:1487294682
Name:PORTERFIELD, DANIEL SCOTT
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
Last Name:PORTERFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC BOX 20116
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-440-1947
Mailing Address - Fax:
Practice Address - Street 1:BUILDING RR612
Practice Address - Street 2:LOOP RD
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-440-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman