Healthcare Provider Details

I. General information

NPI: 1548216120
Provider Name (Legal Business Name): PORTER RADIATION ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HARBOR BLVD
PORT CHARLOTTE FL
33952-6720
US

IV. Provider business mailing address

3080 HARBOR BLVD
PORT CHARLOTTE FL
33952-6720
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-0111
  • Fax:
Mailing address:
  • Phone: 941-625-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN H PORTER
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: M.D.
Phone: 941-924-8700