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Individual
STACY PORTER
Active
Individual
STACY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
43003
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43003
ARIZONA MEDICAL LICENSE
AZ
Enumeration date
07/12/2007
Last updated
01/05/2015
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