Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 239 | KY |
Y | 222Z00000X | Podiatrist | 239 | KY |
N | 213ES0131X | Foot Surgery | KY239 | KY |
NPI | 1265435093 |
---|---|
Provider Name | Roger D Porter |
First Address | Fairfield, OH 45014-4671 |
Second Address | Alexandria, KY 41001-1041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80002397 | (05) | KY |
P00141188 | RAILROAD MEDICARE (01) | KY |