Individual
JEFFREY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6350
(816) 271-6753
Mailing address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6350
(816) 271-6753
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2010000185
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
2016019080
MO
Other
Enumeration date
05/24/2016
Last updated
07/08/2019
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