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NPI Code Detail

MEDICARE: DR. JOEL G PORTER M.D.

MEDICARE: DR. JOEL G PORTER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician91184597-1205UT

General Provider Information

NPI Number : 1417977075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOEL G PORTER M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2075 UNIVERSITY PARK BLVD
Second Line :
City : LAYTON
State : UT
Zip : 84041-1611
Country : US
Telephone Number : 801-779-6200
Fax Number : 801-779-6203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 01/19/2026

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