Individual
DANIEL PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
1616 E LEHI RD, MESA, AZ 85203-1211
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
007802
AZ
Other
Enumeration date
02/09/2017
Last updated
05/21/2020
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