Individual
DR. JASON L. PORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3640 MAIN ST, SUITE 101, SPRINGFIELD, MA 01107-1145
(413) 781-9000
(413) 781-7988
Mailing address
212 FARMINGTON RD, LONGMEADOW, MA 01106-1554
(413) 567-0885
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
151546
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3154656
—
MA
01
—
J16771
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
MA
Enumeration date
08/21/2006
Last updated
07/08/2013
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