Healthcare Provider Details

I. General information

NPI: 1750340915
Provider Name (Legal Business Name): JILL Y PORTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W UNION ST STE A
ATHENS OH
45701-2313
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-594-2456
  • Fax: 740-594-9630
Mailing address:
  • Phone: 740-594-2456
  • Fax: 740-594-9630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-007469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: