Provider Demographics
NPI:1689664112
Name:PORTO, DENNIS P (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:PORTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-222-0677
Mailing Address - Fax:515-222-0019
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-222-0677
Practice Address - Fax:515-222-0019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27404207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA028989Medicaid
IA28989Medicare ID - Type Unspecified
IA028989Medicaid