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General NPI Number Information
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NPI Number | 1265435093
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Entity Type | Individual
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Provider Name | ROGER D PORTER DPM
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 7579 ALEXANDRIA PIKE
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City | ALEXANDRIA
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State | KY
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Zip | 41001-1041
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Country | US
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Telephone | 859-635-6666
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Fax | 859-635-6607
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Provider Business Mailing Address
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Address Line | 6200 PLEASANT AVE STE 3
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City | FAIRFIELD
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State | OH
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Zip | 45014-4671
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Country | US
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Telephone | 513-829-9333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 239
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | KY239
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License Number State | KY
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