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:
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Health care specialties

SpecialtyCodeLicense #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 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770577728 NPPES
Idaho MEDICAID 804187300
Idaho Other 000010004000
Idaho Other 42291

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