MEDICARE: DR. STEVEN G. PORTER D.N.

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	174400000X	Specialist	0006	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00RK19	OTHER	NM	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1689789091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN G. PORTER D.N.

Provider Business Mailing Address
First Line	:	3607 VINYARD RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8102
Country	:	US
Telephone Number	:	816-721-7806
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 VINYARD RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8102
Country	:	US
Telephone Number	:	816-721-7806
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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