Individual
ANDREW PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5424 E SOUTHERN AVE, STE 101, MESA, AZ 85206-3621
(480) 654-6200
Mailing address
5424 E SOUTHERN AVE STE 101, MESA, AZ 85206-3621
(480) 654-6200
(480) 654-6214
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3114
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
913956
—
AZ
Enumeration date
07/03/2006
Last updated
03/29/2014
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