Individual
DR. ROBERT CHARLES PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
605 FULTON AVE, SUITE 2002, ROCKFORD, IL 61103-4179
(815) 964-6334
(815) 964-1162
Mailing address
605 FULTON AVE, SUITE 2002, ROCKFORD, IL 61103-4179
(815) 964-6334
(815) 964-1162
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036054450
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036054450
—
IL
Enumeration date
03/01/2007
Last updated
07/08/2007
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