Provider Demographics
NPI:1033168349
Name:PORTER, MICHAEL CHAMBERS
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHAMBERS
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:224 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6332
Mailing Address - Country:US
Mailing Address - Phone:910-577-7575
Mailing Address - Fax:910-577-9379
Practice Address - Street 1:224 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6332
Practice Address - Country:US
Practice Address - Phone:910-577-7575
Practice Address - Fax:910-577-9379
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011KJOtherBLUE CROSS/BLUE SHIELD
NC7908124Medicaid
U21560Medicare UPIN
NC011KJOtherBLUE CROSS/BLUE SHIELD