Individual
CHRISTOPHER A PORTER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1608 N STOCKTON HILL RD, KINGMAN, AZ 86401-4141
(928) 718-0180
Mailing address
3269 STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
50103
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
784613000
—
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
05
—
ENROLLED
—
WI
Enumeration date
07/12/2007
Last updated
02/18/2016
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