Sporterdo LLC

NPI #1023344272 in Provo, Utah

Provider Information

NPI Number: 1023344272
Entity Type: Organization
Organization Name: Sporterdo LLC
Primary Specialty: Family Medicine
Enumeration Date: Oct 22, 2009
Last Updated: Oct 22, 2009

Practice Location

Address: 3650 N UNIVERSITY AVE
Address 2: SUITE 200
City: Provo
State: Utah
ZIP Code: 84604-6656
Phone: (801) 375-7100

Authorized Official

Name: DR. STUART PORTER, D.O.
Title: PHYSICIAN
Phone: (801) 375-7100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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