Individual
ETHAN JAMES PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 426-2108
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2024035388
MO
208M00000X
Hospitalist Physician
Primary
2024035388
MO
Other
Enumeration date
04/20/2021
Last updated
05/12/2025
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