Healthcare Provider Details

I. General information

NPI: 1518980747
Provider Name (Legal Business Name): JOHN A PORTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 PARK PLACE STE 406
MONTGOMERY AL
36106
US

IV. Provider business mailing address

1758 PARK PLACE STE 406
MONTGOMERY AL
36106
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-1500
  • Fax: 334-288-7763
Mailing address:
  • Phone: 334-284-1500
  • Fax: 334-288-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9516
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: