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Individual
RUSSELL PORTER
Active
Individual
RUSSELL PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
136530
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
136530
NY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
136530
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00598458
—
NY
01
—
2590505
UNEMPLOYMENT ER
—
01
—
36A761
BCBS
—
01
—
559637
US HEALTHCARE
—
01
—
927080
PHS FOR REFERRALS
—
01
—
AB45677
MDNY
—
01
—
AP970
OXFORD
—
01
—
CFP1365303
WC
NY
01
—
OC7613
PHS
—
Enumeration date
01/06/2006
Last updated
03/07/2023
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