Provider Demographics
NPI:1407389372
Name:PORCHE, KEN M (MD, MA)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:M
Last Name:PORCHE
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Gender:M
Credentials:MD, MA
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Mailing Address - Street 1:4018 PRYTANIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3856
Mailing Address - Country:US
Mailing Address - Phone:985-226-7182
Mailing Address - Fax:
Practice Address - Street 1:175 NORTH MEDICAL DRIVE EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-3856
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2023-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT13344916-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery