Healthcare Provider Details

I. General information

NPI: 1215989546
Provider Name (Legal Business Name): JAMES R PORTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 1400
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

1101 MADISON ST SUITE 1400
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6266
  • Fax: 206-622-1052
Mailing address:
  • Phone: 206-386-6266
  • Fax: 206-622-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00030361
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number17336
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: