Individual
GREGORY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
707 CHESTNUT ST, SOUTH CHARLESTON, WV 25309-2003
(304) 768-8500
(304) 768-8530
Mailing address
707 CHESTNUT ST, SOUTH CHARLESTON, WV 25309-2003
(304) 768-8500
(304) 720-8722
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00672
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718067
WV BCBS
WV
01
—
3000325
OH BWC
OH
Enumeration date
01/13/2006
Last updated
10/22/2012
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