Individual
MR. JEROME J PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
719 E NEW ST, DELAND, FL 32724-5811
(386) 738-1891
Mailing address
719 E NEW ST, DELAND, FL 32724-5811
(386) 738-1891
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
676191796
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
676191796
—
FL
Enumeration date
09/28/2010
Last updated
09/28/2010
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