ETHAN JAMES PORTER

ROLLA, MO
NPI1194306126
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy208M00000X Hospitalist
(Licence: MO  2024035388)
Additional Taxonomies207R00000X Internal Medicine
(Licence: MO  2024035388)
Enumeration Date2021-04-20
Last Update Date2024-10-11
Business Address
ETHAN JAMES PORTER DO
1000 W 10TH ST
ROLLA, MO 65401-2905
Phone number: 573-364-9000
Mailing Address
ETHAN JAMES PORTER DO
1050 W 10TH ST
ROLLA, MO 65401-2905
Phone number: 573-364-9000