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Individual

LEVI PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
19636 N 27TH AVE, SUITE 106, PHOENIX, AZ 85027-4013
(623) 516-8252
(623) 516-8253
Mailing address
5281 N 99TH AVE, SUITE 100, GLENDALE, AZ 85305-3105
(623) 516-8252
(623) 516-8253

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2778
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2778
AZ LICENSE
AZ
05
743271
AZ
Enumeration date
10/24/2006
Last updated
04/18/2014
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