Search › Missouri › 208M00000X
Ethan Porter, DO
NPI 1194306126 · on the registry since 2021 · sole proprietor
Practice
- Address
- 1000 W 10th St
Rolla, MO 65401 - Phone
- (573) 364-9000
- Fax
- (573) 426-2108
- Organisation at this address
- Miracl, Llc
Lifenet, Inc.
Palmaris Imaging, Llc
Glenn A Kunkel Md Llc
Ameripath Indianapolis PcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 80
Additional practice sites
- 604 W 6th St Ste A, Rolla, MO
- 1000 W 10th St, Rolla, MO
- 1125 N College Ave # Slot100, Fayetteville, AR
Registry record
- Primary taxonomy
- 208M00000X
208M00000X
- Also registered as
- 207R00000X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-08-06
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri