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Individual

CLIFFORD A PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
419 SOUTH L STREET SUITE 101, TACOMA, WA 98405
(253) 383-5949
(253) 383-5953
Mailing address
419 SOUTH L STREET SUITE 101, TACOMA, WA 98405
(253) 383-5949
(253) 383-5953

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD00036710
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
161768
L&I
WA
01
5491PO
REGENCE BLUE SHIELD
WA
05
8265175
WA
Enumeration date
11/16/2006
Last updated
02/01/2008
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