Individual
RONALD D PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1610
(681) 342-1626
Mailing address
306 STANAFORD RD, BECKLEY, WV 25801-3142
(304) 255-3436
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
21431
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706470
MSBCBS GROUP
WV
01
—
001713627
BCBS AAP NUMBER
WV
01
—
001907661
MSBCBS
WV
05
—
0067342000
—
WV
05
—
0207026000
—
WV
01
—
1054827
WORKERS COMP INDIVIDUAL
WV
01
—
205542387
AAP TRI CARE NUMBER
WV
01
—
20554238700
WORKERS COMP
WV
01
—
27005299700
TRICARE
WV
01
—
270052997004
TRICARE
WV
01
—
27005299701
WORKERS COMP
WV
05
—
3810006746
—
WV
01
—
8226335
MEDICARE PTAN
WV
01
—
DA0096
RR MEDICARE
WV
01
—
DF0767
RR MEDICARE
WV
01
—
P00211135
RR MEDICARE
WV
01
—
P00407274
RR MEDICARE
WV
Enumeration date
06/14/2006
Last updated
01/20/2017
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