Individual
DR. RON WADE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Mailing address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-7271
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004000
BLUE SHIELD
ID
01
—
42291
BLUE CROSS
ID
05
—
804187300
—
ID
Enumeration date
09/06/2005
Last updated
01/06/2026
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