Provider Demographics
NPI:1467412734
Name:PORTERA, CHARLES A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:PORTERA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3851 PIPER ST STE U230
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6901
Mailing Address - Country:US
Mailing Address - Phone:907-868-2075
Mailing Address - Fax:907-312-5882
Practice Address - Street 1:3851 PIPER ST STE U230
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-6901
Practice Address - Country:US
Practice Address - Phone:907-868-2075
Practice Address - Fax:907-312-5882
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK69822086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK151809Medicaid
AKK165955Medicare PIN
TN3854474Medicare PIN