Individual
CHARLES B PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4000 CAMBRIDGE ST STE G600, KANSAS CITY, KS 66160-8500
(913) 588-9600
(913) 588-9770
Mailing address
4000 CAMBRIDGE ST STE G600, KANSAS CITY, KS 66160-8501
(913) 588-9600
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
04-17907
KS
207RC0000X
Cardiovascular Disease Physician
R7C72
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051569
BCBS KS
KS
05
—
100202670A
—
KS
05
—
100202670B
—
KS
01
—
10338011
BCBS KC
—
05
—
202205704
—
MO
Enumeration date
07/24/2006
Last updated
01/15/2019
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