Individual
JOHN C PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
444 HOSPITAL WAY, SUITE 801, POCATELLO, ID 83201-2745
(800) 613-4012
(208) 233-3416
Mailing address
3544 E 17TH ST, STE 104, AMMON, ID 83406-6910
(208) 522-2922
(208) 522-6330
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
NP376A
ID
Other
Enumeration date
06/02/2006
Last updated
05/11/2016
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