Individual
ANTHONY JEROME PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 W NASA BLVD, SUITE 101, MELBOURNE, FL 32901-2605
(321) 308-0659
(321) 309-2881
Mailing address
1515 W NASA BLVD, SUITE 101, MELBOURNE, FL 32901-2605
(321) 308-0659
(321) 309-2881
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01058940A
IN
207N00000X
Dermatology Physician
Primary
ME96233
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1358244
AETNA
FL
01
—
246877
WELLCARE
FL
05
—
276029100
—
FL
01
—
55044
BLUE CROSS BLUE SHIELD
FL
01
—
7650363
AETNA
FL
01
—
P00415676
RAILROAD MEDICARE
FL
Enumeration date
06/07/2006
Last updated
09/30/2014
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