Provider Demographics
NPI:1790996213
Name:PORTER, GREGORY JAMES SR (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:PORTER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1701 W ST MARYS
Mailing Address - Street 2:SUITE C117
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-884-8060
Mailing Address - Fax:520-884-5048
Practice Address - Street 1:1701 W ST MARYS
Practice Address - Street 2:SUITE C117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-884-8060
Practice Address - Fax:520-884-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37462Medicare UPIN