Individual
KEITH PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
391 SOUTHCREST CIR STE 108, SOUTHAVEN, MS 38671-4775
(662) 349-2659
Mailing address
391 SOUTHCREST CIR STE 108, SOUTHAVEN, MS 38671-4775
(901) 830-4211
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26479
MS
Other
Enumeration date
06/02/2015
Last updated
06/03/2019
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