Individual
JACOB RUSSELL PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
333 N 300 W, SALT LAKE CITY, UT 84103-1215
(014) 637-4158
Mailing address
333 N 300 W, SALT LAKE CITY, UT 84103-1215
(480) 318-0354
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
00000000
IL
Other
Enumeration date
04/12/2017
Last updated
08/18/2020
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