Healthcare Provider Details

I. General information

NPI: 1841325552
Provider Name (Legal Business Name): DONALD ELWOOD PORTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 EAST LOWELL STREET
TUCSON AZ
85721
US

IV. Provider business mailing address

5387 E RIVER RD
TUCSON AZ
85718-7247
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-5733
  • Fax: 520-626-2416
Mailing address:
  • Phone: 520-529-1908
  • Fax: 520-626-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number13521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: