Individual
DAVID PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NPP
Contact information
Practice address
4000 MEDICAL CENTER DR, STE 504, FAYETTEVILLE, NY 13066
(315) 329-2650
(315) 744-1925
Mailing address
4000 MEDICAL CENTER DR, SUITE 504, FAYETTEVILLE, NY 13066
(315) 329-2650
(315) 744-1925
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
625493
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402419
NY
Other
Enumeration date
06/25/2018
Last updated
02/02/2023
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