Individual
DR. SANDY J PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 567-2180
(317) 567-2191
Mailing address
PO BOX 7232, DEPT 165, INDIANAPOLIS, IN 46207-7232
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01062332A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000565604
ANTHEM
IN
05
—
200905720
—
IN
Enumeration date
05/06/2008
Last updated
03/25/2021
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