Individual
MARK DOUGLAS PORTA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 KINGS HWY, LSUHSC DEPT. OF GASTROENTEROLOGY, SHREVEPORT, LA 71130
(318) 813-2502
Mailing address
1501 KINGS HWY, LSUHSC DEPT. OF GASTROENTEROLOGY, SHREVEPORT, LA 71130
(318) 813-2502
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
206897
LA
Other
Enumeration date
04/12/2012
Last updated
07/30/2015
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