Provider Demographics
NPI:1740255819
Name:PORTER, STEVEN A (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 E SKYLINE DR
Mailing Address - Street 2:STE 600
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4857
Mailing Address - Country:US
Mailing Address - Phone:801-387-2550
Mailing Address - Fax:801-387-2564
Practice Address - Street 1:1508 E SKYLINE DR
Practice Address - Street 2:STE 600
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4857
Practice Address - Country:US
Practice Address - Phone:801-387-2550
Practice Address - Fax:801-387-2564
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3090962-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00050418OtherRAILROAD MEDICARE
UT005734801Medicare PIN
UTF34383Medicare UPIN