Healthcare Provider Details

I. General information

NPI: 1164453494
Provider Name (Legal Business Name): STEVEN J. PORTER MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 N VILLA ST STE A
PORTERVILLE CA
93257-3252
US

IV. Provider business mailing address

386 N VILLA ST STE A
PORTERVILLE CA
93257-3252
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-4711
  • Fax: 559-781-4712
Mailing address:
  • Phone: 559-781-4711
  • Fax: 559-781-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN J. PORTER
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 559-781-4711