Provider Demographics
NPI:1922164607
Name:PORTER, ANASTASIA L (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1101 MADISON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1340
Mailing Address - Country:US
Mailing Address - Phone:206-215-2020
Mailing Address - Fax:206-215-2022
Practice Address - Street 1:1101 MADISON ST STE 600
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1340
Practice Address - Country:US
Practice Address - Phone:206-215-2020
Practice Address - Fax:206-215-2022
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038910207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1035476Medicaid
WAAB28931Medicare ID - Type Unspecified
WAH60866Medicare UPIN