person
Lance Wesley Port, PA-C
Medical Physician Assistant in Salmon, Idaho
NPI 1578222188

Lance Wesley Port is a Medical Physician Assistant based in Pocatello, ID and is specialized in Medical. Lance Wesley Port practices in Salmon, ID and has the professional credentials of PA-C. The NPI Number for Lance Wesley Port is 1578222188 and holds a License No. (Idaho).

The current practice location address for Lance Wesley Port is 103 S Daisy St, Salmon, ID and can be reached out via phone at 208-756-6212.

Location: 103 S Daisy St, Salmon, ID, 83202-5173
person
Provider Profile Details
NPI Number
1578222188
Provider Name
Lance Wesley Port
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
103 S Daisy St, Salmon, ID, 83202-5173
Phone Number
208-756-6212
Fax Number
Provider Enumeration Date
12/10/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
103 S Daisy St
City
State
Zip
83467
Phone Number
208-756-6212
Fax Number
person
Provider Business Mailing Address Details
Address
103 S Daisy St
City
State
Zip
83467
Phone Number
208-756-6212
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
()
Definition
Definition to come...
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