Provider Demographics
NPI:1114093432
Name:PORTER, LORI J (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:KUTKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2925 DEBARR RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2959
Mailing Address - Country:US
Mailing Address - Phone:907-777-1800
Mailing Address - Fax:907-278-2066
Practice Address - Street 1:2925 DEBARR RD STE 230
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2959
Practice Address - Country:US
Practice Address - Phone:907-777-1800
Practice Address - Fax:907-278-2066
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116966208000000X
AK121717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1014373Medicaid