Individual
SCOTT S PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1614 MAHAN CENTER BLVD STE 104, TALLAHASSEE, FL 32308-5475
(850) 765-7292
(850) 765-5938
Mailing address
1614 MAHAN CENTER BLVD STE 104, TALLAHASSEE, FL 32308-5475
(850) 765-7292
(850) 765-5938
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY10129
FL
103TC0700X
Clinical Psychologist
PY10129
FL
2084N0400X
Neurology Physician
374
ND
2084N0400X
Neurology Physician
PY10129
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13124
—
ND
05
—
372126400
—
MN
05
—
JJ944Z
—
FL
Enumeration date
07/18/2006
Last updated
01/18/2021
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