Healthcare Provider Details

I. General information

NPI: 1447876057
Provider Name (Legal Business Name): BROOKE ELIZABETH PORTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

1 HOSPITAL DR RM M349
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 916-588-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2020017452
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number04-53462
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: