Porter, Anthony Jerome

Porter, Anthony Jerome is an individual health care provider with primary practice located at 1515 W Nasa Blvd Suite 101, Melbourne FL 32901-2605. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Porter, Anthony Jerome can be contacted via phone (321) 308-0659.

Contact Information

Primary practice address
1515 W Nasa Blvd Suite 101 Melbourne FL 32901-2605
Phone: (321) 308-0659
Fax: (321) 309-2881
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 01058940A Indiana
Allopathic & Osteopathic Physicians / Dermatology 207N00000X ME96233 Florida

Profile Details

NPI number 1013957133
LBN Legal business name Porter, Anthony Jerome
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2006
Last updated Sep 30th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013957133 NPPES
Florida Other 7650363 AETNA
Florida Other 1358244 AETNA
Florida Other 55044 AETNA
Florida MEDICAID 276029100 AETNA
Florida Other 246877 AETNA
Florida Other P00415676 AETNA

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