Porter, Jeffrey Sam

Porter, Jeffrey Sam is an individual health care provider with primary practice located at 523 N 3Rd St , Brainerd MN 56401-3054. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Porter, Jeffrey Sam can be contacted via phone (218) 829-2861.

Contact Information

Primary practice address
523 N 3Rd St Brainerd MN 56401-3054
Phone: (218) 829-2861
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 46608 Minnesota

Profile Details

NPI number 1164496345
LBN Legal business name Porter, Jeffrey Sam
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 15th, 2006
Last updated Jan 29th, 2016 - about 10 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 1164496345 NPPES
Minnesota MEDICAID 133444100

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