Individual
DR. JUSTIN ROSS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 NW 138TH ST, OKLAHOMA CITY, OK 73134-2513
(405) 242-4100
(405) 775-9356
Mailing address
PO BOX 108835, OKLAHOMA CITY, OK 73101-8835
(405) 550-8040
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
29694
OK
208VP0014X
Interventional Pain Medicine Physician
Primary
29694
OK
Other
Enumeration date
04/01/2008
Last updated
11/12/2014
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