Individual
MR. JOHN RICHARD PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9040 JACKSON AVE, MAMC FAMILY MED DEPT, TACOMA, WA 98431-1100
(253) 968-0770
Mailing address
7024 CAMEO DR SW, LAKEWOOD, WA 98498-3417
(253) 582-3555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002496
WA
Other
Enumeration date
06/15/2006
Last updated
07/08/2007
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