Individual
DUSTIN BLAKE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 HILAND AVE STE H, BURLEY, ID 83318-2688
(208) 677-6082
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-14207
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2013
Last updated
03/03/2026
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