Individual
CHRISTIAN MICHAEL PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
210 VILLAGE CENTER BLVD STE 200, MYRTLE BEACH, SC 29579-6706
(843) 353-3460
Mailing address
210 VILLAGE CENTER BLVD STE 140, MYRTLE BEACH, SC 29579-6706
(843) 353-3460
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/12/2020
Last updated
04/13/2023
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