Individual
DEBRA A PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
(608) 260-2956
Mailing address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
(608) 260-2956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
576-23
WI
363AM0700X
Medical Physician Assistant
576-023
WI
363AS0400X
Surgical Physician Assistant
576-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750330544
—
WI
Enumeration date
05/09/2006
Last updated
11/11/2020
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