Kris Daniel Porter, Md, Pa | |
94 Bluff Vw Aledo TX 76008-4580 | |
(817) 441-6136 | |
(817) 441-6145 |
Full Name | Kris Daniel Porter, Md, Pa |
---|---|
Speciality | Internal Medicine |
Location | 94 Bluff Vw, Aledo, Texas |
Authorized Official Name and Position | Kris Daniel Porter (CEO) |
Authorized Official Contact | 8174416136 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Kris Daniel Porter, Md, Pa 94 Bluff Vw Aledo TX 76008-4580 Ph: (817) 441-6136 | Kris Daniel Porter, Md, Pa 94 Bluff Vw Aledo TX 76008-4580 Ph: (817) 441-6136 |
NPI Number | 1609245083 |
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Provider Enumeration Date | 09/16/2015 |
Last Update Date | 09/16/2015 |
Medicare PECOS PAC ID | 8921301565 |
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Medicare Enrollment ID | O20160119000867 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609245083 | NPI | - | NPPES |
J8509 | Other | TX | MEDICAL LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | J8509 (Texas) | Primary |
Provider Name | Kris D Porter |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1558379230 PECOS PAC ID: 9133136658 Enrollment ID: I20060501000249 |
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