Individual
DR. JOHN CHARLES PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6527 W BLOOMFIELD RD, GLENDALE, AZ 85304-1652
(623) 764-2894
(623) 878-8712
Mailing address
PO BOX 5415, GLENDALE, AZ 85312-5415
(602) 467-8605
(602) 467-8682
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
15286
AZ
208VP0000X
Pain Medicine Physician
15286
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247173
—
AZ
Enumeration date
12/19/2006
Last updated
04/11/2014
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