Healthcare Provider Details

I. General information

NPI: 1033168349
Provider Name (Legal Business Name): DR. MICHAEL CHAMBERS PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MICHAEL PORTER D.P.M.

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 MEMORIAL DR
JACKSONVILLE NC
28546-6332
US

IV. Provider business mailing address

224 MEMORIAL DR
JACKSONVILLE NC
28546-6332
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-7575
  • Fax: 910-577-9379
Mailing address:
  • Phone: 910-577-7575
  • Fax: 910-577-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: