Provider Demographics
NPI:1386620680
Name:PORTER, JEFFERY SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:PORTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 CARPENTER RD BLDG 525
Mailing Address - Street 2:ROOM 1015
Mailing Address - City:FT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:703-696-3614
Mailing Address - Fax:703-696-9248
Practice Address - Street 1:401 CARPENTER RD BLDG 525
Practice Address - Street 2:ROOM 120
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics