Healthcare Provider Details

I. General information

NPI: 1932208568
Provider Name (Legal Business Name): ROBERT S PORT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9602 STOCKDALE HWY
BAKERSFIELD CA
93311
US

IV. Provider business mailing address

9602 STOCKDALE HWY
BAKERSFIELD CA
93311
US

V. Phone/Fax

Practice location:
  • Phone: 661-633-5000
  • Fax: 661-633-2500
Mailing address:
  • Phone: 661-633-5000
  • Fax: 661-633-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number134786-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG88069
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101280265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: