Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0600X | Clinical Neurophysiologist | 163552 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 201501835NP-PP | OR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 202002489CNS-PP | OR |
NPI | 1013932425 |
---|---|
Provider Name | Mr. Lee W Porter |
First Address | Eugene, OR 97404-2485 |
Second Address | Keizer, OR 97303-5324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 21/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131VX | BLUE CROSS PROVIDER ID (01) | NC |
3072541580 | PECOS PAC ID (01) | OR |
500709395 | (05) | OR |
I20160510002557 | PECOS PAC ENROLLMENT ID (01) | OR |
P08873 | (02) | NC |