Individual
DR. BURDETT ROY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 887-6133
(570) 887-4464
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
217587-1
NY
207L00000X
Anesthesiology Physician
Primary
MD042659L
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
217587-1
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD042659L
PA
2083C0008X
Clinical Informatics Physician
MD042659L
PA
208VP0014X
Interventional Pain Medicine Physician
217587-1
NY
208VP0014X
Interventional Pain Medicine Physician
MD042659L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017472240001
—
PA
05
—
01950201
—
NY
01
—
050075753
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039832
PA MEDICARE GROUP
OK
Enumeration date
02/13/2006
Last updated
03/01/2021
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