Organization
SPORTERDO LLC
Active
Other names
Ingegrative Medical Assicates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STUART PORTER D.O. (PHYSICIAN)
(801) 375-7100
Entity
Organization
Contact information
Practice address
3650 N UNIVERSITY AVE, SUITE 200, PROVO, UT 84604-6656
(801) 375-7100
(801) 375-7102
Mailing address
3650 N UNIVERSITY AVE, SUITE 200, PROVO, UT 84604-6656
(801) 375-7100
(801) 375-7102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
288579 1204
UT
Other
Enumeration date
10/22/2009
Last updated
10/22/2009
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