Healthcare Provider Details

I. General information

NPI: 1588723795
Provider Name (Legal Business Name): ANTHONY F PORTO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET ST # 121
KANSAS CITY MO
64114
US

IV. Provider business mailing address

1010 CARONDELET SUITE #121
KANSAS CITY MO
64114
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-6122
  • Fax: 816-941-0880
Mailing address:
  • Phone: 816-941-6122
  • Fax: 816-941-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number6842
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: