Provider Demographics
NPI:1184894354
Name:PORTER, GARY S (NP-C)
Entity type:Individual
Prefix:MS
First Name:GARY
Middle Name:S
Last Name:PORTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
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Mailing Address - Street 1:149 DRINKWATER RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1658
Mailing Address - Country:US
Mailing Address - Phone:228-467-8600
Mailing Address - Fax:228-467-8674
Practice Address - Street 1:4540 B SHEPHERDS SQUARD
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525
Practice Address - Country:US
Practice Address - Phone:228-255-8216
Practice Address - Fax:228-255-8219
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR860556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily