Individual
DR. BRIAN R PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12801 IRON BRIDGE RD, SUITE 200, CHESTER, VA 23831-1669
(804) 748-9071
(804) 768-8626
Mailing address
12801 IRON BRIDGE RD, SUITE 200, CHESTER, VA 23831-1669
(804) 748-9071
(804) 768-8626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101-033236
VA
207Q00000X
Family Medicine Physician
Primary
0101033236
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010674
CIGNA
VA
01
—
032845
ANTHEM
VA
01
—
56520
SOUTHERN HEALTH
VA
Enumeration date
09/01/2005
Last updated
01/11/2021
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