=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508029117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ANTHONY F. PORTO, JR.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 CARONDELET DR SUITE #121
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-941-6122
-----------------------------------------------------
Fax | 816-941-0880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 CARONDELET DR SUITE #121
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64114-4859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-941-6122
-----------------------------------------------------
Fax | 816-941-0880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JANE QUARNSTROM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-941-6122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 6842
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------