Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 45030 020 | WI |
NPI | 1033123575 |
---|---|
Provider Name | Dr. Phillip Porter |
First Address | Altoona, WI 54720-2245 |
Second Address | Altoona, WI 54720-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34275200 | (05) | WI |
H73735 | (02) |