Individual
DAVID JOEL PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2118 25TH ST STE E, COLUMBUS, IN 47201-3240
(812) 373-2700
(812) 373-2710
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0146763
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089966
BLUE CROSS ANTHEM
IN
01
—
000000984055
ANTHEM PIN
IN
01
—
080148475
MEDICARE RAILROAD
IN
01
—
1046763
IN MEDICAL LICENSE
IN
01
—
1407861164
GROUP NPI
—
05
—
200126950A
—
IN
Enumeration date
05/03/2006
Last updated
09/09/2024
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