NPI 1578222188

Lance Wesley Port, PAC

Practitioner Medical Physician Assistant Salmon, ID

Practice location

Address: 103 S Daisy St, Salmon, ID 83467
Phone: (208) 756-6212
Mailing address: 13613 N Manning Ln, Pocatello, ID 83202-5173

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X

Other Physician Assistant providers in Idaho →

Registry record

NPI: 1578222188
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Dec 2021
Record last updated: 10 Dec 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.