Provider Demographics
NPI:1407069727
Name:PORTER, ISAAC WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:WILLIAM
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5962 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3895
Mailing Address - Country:US
Mailing Address - Phone:919-876-4064
Mailing Address - Fax:919-876-3159
Practice Address - Street 1:5962 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3895
Practice Address - Country:US
Practice Address - Phone:919-876-4064
Practice Address - Fax:919-876-3159
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122534207W00000X
NC2010-00315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology