MEDICARE: STUART B PORTER D.O.

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
1	207Q00000X	Family Medicine Physician	288579-1204	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689612996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART B PORTER D.O.

Provider Business Mailing Address
First Line	:	3650 N UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	PROVO
State	:	UT
Zip	:	84604-6656
Country	:	US
Telephone Number	:	801-375-7100
Fax Number	:	801-375-7102

Provider Business Practice Location Address
First Line	:	3650 N UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	PROVO
State	:	UT
Zip	:	84604-6656
Country	:	US
Telephone Number	:	801-375-7100
Fax Number	:	801-375-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/01/2009

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Directions to “ STUART B PORTER D.O.” Practice Location

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