Porter, Ron Wade
Porter, Ron Wade is an individual health care provider with primary practice located at 3067 Eagle Dr , Ammon ID 83406-1273. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Porter, Ron Wade can be contacted via phone (208) 522-4600.Contact Information
Primary practice address
3067 Eagle Dr
Ammon ID 83406-1273
Phone: (208) 522-4600
Fax: (208) 552-7521
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | M-7271 | Idaho |
Profile Details
| NPI number | 1770577728 |
|---|---|
| LBN Legal business name | Porter, Ron Wade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 6th, 2005 |
| Last updated | Nov 19th, 2020 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770577728 | NPPES |
| Idaho | MEDICAID | 804187300 | |
| Idaho | Other | 42291 | |
| Idaho | Other | 000010004000 |
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