# SPORTERDO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ingegrative Medical Assicates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023344272
- **Authorized official:** DR. STUART PORTER D.O. (PHYSICIAN)
- **Authorized official phone:** (801) 375-7100

## Contact information

- **Practice address:** 3650 N UNIVERSITY AVE, SUITE 200, PROVO, UT 84604-6656
- **Practice address phone:** (801) 375-7100
- **Practice address fax:** (801) 375-7102
- **Mailing address:** 3650 N UNIVERSITY AVE, SUITE 200, PROVO, UT 84604-6656
- **Mailing address phone:** (801) 375-7100
- **Mailing address fax:** (801) 375-7102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 288579 1204 | UT | Yes |

## Other

- **Enumeration date:** 10/22/2009
- **Last updated:** 10/22/2009