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Individual

RENEE PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
565 ABBOTT RD, BUFFALO, NY 14220
(716) 826-7000
Mailing address
440 BEEBE RD, ILION, NY 13357-3741
(315) 897-6694

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
010940-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02743259
NY
Enumeration date
06/02/2006
Last updated
02/21/2019
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