Provider Demographics
NPI:1891898730
Name:PORTER, EDWARD I (MDIV)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:I
Last Name:PORTER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 ARMSTRONG ROAD
Mailing Address - Street 2:BATTLE CREEK VAMC CHAPLAIN SECTION (012C)
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49071
Mailing Address - Country:US
Mailing Address - Phone:269-966-5600
Mailing Address - Fax:269-660-5008
Practice Address - Street 1:5500 ARMSTRONG ROAD
Practice Address - Street 2:BATTLE CREEK VAMC
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49071
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:269-660-5008
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral