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NPI Code Detail

MEDICARE: DR. MARC J POROT MD

MEDICARE:  DR. MARC J POROT  MD
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
1207L00000XAnesthesiology PhysicianA42809CA
2207LP2900XPain Medicine (Anesthesiology) PhysicianA42809CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000010150034OTHERIDREGENCE BLUE SHIELD
2HB401OTHERIDBLUE CROSS
374138OTHERIDBLUE CROSS OLD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5268236OTHERIDALTIUS OLD
6313072OTHERIDALTIUS

General Provider Information

NPI Number : 1750347159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC J POROT MD
Provider Business Mailing Address
First Line : PO BOX 3129
Second Line :
City : TORRANCE
State : CA
Zip : 90510-3129
Country : US
Telephone Number : 310-792-3914
Fax Number : 855-898-4055
Provider Business Practice Location Address
First Line : 515 S VAN NESS AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90020-4616
Country : US
Telephone Number : 213-493-2086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 12/03/2014

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