Porter, Ryan Todd

Porter, Ryan Todd is an individual health care provider with primary practice located at 98 Poplar St , Blackfoot ID 83221-1758. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Porter, Ryan Todd can be contacted via phone (208) 785-4100.

Contact Information

Primary practice address
98 Poplar St Blackfoot ID 83221-1758
Phone: (208) 785-4100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 447 Montana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-827 Idaho

Profile Details

NPI number 1669556213
LBN Legal business name Porter, Ryan Todd
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2006
Last updated Dec 30th, 2009 - about 17 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 1669556213 NPPES
Montana MEDICAID 4307719
Montana MEDICAID 808517600

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