Provider Demographics
NPI:1801456736
Name:PORTER, JEROLD (BC HIS)
Entity type:Individual
Prefix:MR
First Name:JEROLD
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E MARKET ST STE 7
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2259
Mailing Address - Country:US
Mailing Address - Phone:330-392-8600
Mailing Address - Fax:
Practice Address - Street 1:5000 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2260
Practice Address - Country:US
Practice Address - Phone:330-392-8600
Practice Address - Fax:330-392-6315
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment