Provider Demographics
NPI:1083096747
Name:JOHN K.L. PORTER, D.O., PC
Entity type:Organization
Organization Name:JOHN K.L. PORTER, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-265-8455
Mailing Address - Street 1:1758 PARK PL STE 100B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1133
Mailing Address - Country:US
Mailing Address - Phone:334-265-8455
Mailing Address - Fax:334-265-8456
Practice Address - Street 1:1758 PARK PL STE 100B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1133
Practice Address - Country:US
Practice Address - Phone:334-265-8455
Practice Address - Fax:334-265-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty