Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 12856 | WV |
N | 207PP0204X | Pediatric Emergency Physician | 12856 | WV |
N | 207R00000X | Internist | 12856 | WV |
N | 111NI0900X | Internist | 12856 | WV |
NPI | 1639376593 |
---|---|
Provider Name | Dr. Edwin Porres |
First Address | Huntington, WV 25701-3804 |
Second Address | Huntington, WV 25701-3804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 13/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0479101 | (05) | OH |
1639376593 | (05) | WV |
64694524 | (05) | KY |
930050958 | MEDICARE-RR PROVIDER NUMBER (01) | WV |
D49350 | (02) | WV |