Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 52794 | AZ |
NPI | 1013200591 |
---|---|
Provider Name | Laura Porter |
First Address | Phoenix, AZ 85004-4527 |
Second Address | Phoenix, AZ 85004-4527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 19/09/2016 |