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General NPI Number Information
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NPI Number | 1588849954
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Entity Type | Organization
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Legal Business Name | GREGORY J PORTER MD INC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 400 SIERRA COLLEGE DR STE B
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5093
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Country | US
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Telephone | 530-272-3428
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Fax | 530-272-3429
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Provider Business Mailing Address
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Address Line | PO BOX 25033
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City | SANTA ANA
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State | CA
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Zip | 92799-5033
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Country | US
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Telephone | 714-347-1000
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Fax | 714-347-1082
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY J. PORTER
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Credential | M.D.
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Telephone | 714-347-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G72310
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G72310
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License Number State | CA
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