Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01038677A | IN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1038677A | IN |
NPI | 1194771501 |
---|---|
Provider Name | Mr. David A Porter |
First Address | Indianapolis, IN 46280-2301 |
Second Address | Indianapolis, IN 46280-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200034164 | RR MEDICARE (01) | IN |
200161470A | (05) | IN |
G13340 | (02) | IN |