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General NPI Number Information
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NPI Number | 1467412734
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Entity Type | Individual
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Provider Name | CHARLES A PORTERA JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 3851 PIPER ST STE U230
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City | ANCHORAGE
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State | AK
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Zip | 99508-6901
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Country | US
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Telephone | 907-868-2075
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Fax | 907-312-5882
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Provider Business Mailing Address
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Address Line | 3851 PIPER ST STE U230
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City | ANCHORAGE
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State | AK
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Zip | 99508-6901
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Country | US
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Telephone | 907-868-2075
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Fax | 907-312-5882
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 6982
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License Number State | AK
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