# GREGORY PORTER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1053390450
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 00672 | WV | Yes |

## Other

- **Enumeration date:** 01/13/2006
- **Last updated:** 10/22/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001718067 | WV BCBS | WV |
| 01 | — | 3000325 | OH BWC | OH |