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General NPI Number Information
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NPI Number | 1740219237
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Entity Type | Individual
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Provider Name | JOHN ALFRED PORTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 4 COULTER RD #58
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1122
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Country | US
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Telephone | 315-462-1485
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Fax | 315-462-2619
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVE BOX 652
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-7741
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Fax | 585-756-7750
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 146697
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License Number State | NY
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