Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 35056347P | OH |
NPI | 1003824921 |
---|---|
Provider Name | Dr. Eric J Porter |
First Address | Columbus, OH 43271-0776 |
Second Address | Lima, OH 45801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000141855 | ANTHEM (01) | OH |
2136978 | (05) | OH |
27156843500 | WORKERS COMPENSATION (01) | OH |
D33046 | (02) |