Provider Demographics
NPI:1740219237
Name:PORTER, JOHN ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALFRED
Last Name:PORTER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 652
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7741
Mailing Address - Fax:585-756-7750
Practice Address - Street 1:4 COULTER RD
Practice Address - Street 2:#58
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-1485
Practice Address - Fax:315-462-2619
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-07
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Provider Licenses
StateLicense IDTaxonomies
NY1466972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX70002OtherGENEVA GENERAL HOSPITAL
NY0062375Medicaid
C58308Medicare UPIN
NY0062375Medicaid