Provider Demographics
NPI:1750340915
Name:PORTER, JILL Y (DO)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:Y
Last Name:PORTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:740-594-2456
Mailing Address - Fax:740-594-9630
Practice Address - Street 1:265 W UNION ST STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2313
Practice Address - Country:US
Practice Address - Phone:740-594-2456
Practice Address - Fax:740-594-9630
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342174Medicaid
OH4090107OtherMEDICARE
OH000000272687OtherANTHEM
OHPO4090103Medicare ID - Type Unspecified