Provider Demographics
NPI:1649310798
Name:PORTER, BRUCE ARNOLD (MD, FACR)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ARNOLD
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BOYLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1389
Mailing Address - Country:US
Mailing Address - Phone:206-329-6767
Mailing Address - Fax:206-323-6989
Practice Address - Street 1:1001 BOYLSTON AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1389
Practice Address - Country:US
Practice Address - Phone:206-329-6767
Practice Address - Fax:206-323-6989
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000215042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00021504OtherWASHINGTON STATE LICENSE
WAAP7436808OtherDEA
WAAP7436808OtherDEA