Healthcare Provider Details

I. General information

NPI: 1689789091
Provider Name (Legal Business Name): STEVEN G. PORTER D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 VINYARD RD
BATES CITY MO
64011-8102
US

IV. Provider business mailing address

3607 VINYARD RD
BATES CITY MO
64011-8102
US

V. Phone/Fax

Practice location:
  • Phone: 816-721-7806
  • Fax:
Mailing address:
  • Phone: 816-721-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: