Healthcare Provider Details

I. General information

NPI: 1326018540
Provider Name (Legal Business Name): KEITH J PORCHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-3961
  • Fax: 602-271-3951
Mailing address:
  • Phone: 623-277-1128
  • Fax: 866-561-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21623
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: