Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 35071752 | OH |
NPI | 1194718189 |
---|---|
Provider Name | Robert Porter |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 28/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000234755 | UNISON (01) | OH |
000000558132 | ANTHEM (01) | OH |
0304914 | BCMH (01) | OH |
1024955900001 | (05) | PA |
2086899 | (05) | OH |
4077752 | AETNA (01) | OH |
746939 | BUCKEYE (01) | OH |
G92880 | (02) | OH |
P00420608 | RAILROAD MEDICARE (01) | OH |