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General NPI Number Information
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NPI Number | 1063584449
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Entity Type | Individual
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Provider Name | STEPHEN TROY PORTER CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 135 S POWER RD STE 110
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City | MESA
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State | AZ
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Zip | 85206-5245
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Country | US
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Telephone | 480-745-8577
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Fax |
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Provider Business Mailing Address
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Address Line | 20641 S 196TH ST
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6242
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Country | US
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Telephone | 618-322-4507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0827
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209006282
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License Number State | IL
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