Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 6982 | AK |
NPI | 1467412734 |
---|---|
Provider Name | Dr. Charles A Portera JR. |
First Address | Anchorage, AK 99508-6901 |
Second Address | Anchorage, AK 99508-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 29/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151809 | (05) | AK |