Individual
SAMUEL GRANT PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 W FRONTIER LN, OLATHE, KS 66061
(913) 397-7800
Mailing address
961 E SHALIMAR DR, COLUMBIA, MO 65202-1093
(309) 202-7445
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-38118
KS
Other
Enumeration date
07/01/2014
Last updated
01/29/2019
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