Individual
DOROTHY WHATLEY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3635 S CLYDE MORRIS BLVD, SUITE 100, PORT ORANGE, FL 32129-2300
(386) 788-1242
(386) 756-8802
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 483-5826
(904) 265-6409
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106692
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006441000
—
FL
01
—
Y0CE7
BCBS
FL
Enumeration date
07/24/2012
Last updated
05/23/2013
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