Provider Demographics
NPI:1073591459
Name:PORRAS, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:PORRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ROSINANTE RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2224
Mailing Address - Country:US
Mailing Address - Phone:915-598-2100
Mailing Address - Fax:915-591-4069
Practice Address - Street 1:1740 CURIE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2901
Practice Address - Country:US
Practice Address - Phone:915-351-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742840162Medicaid
TX1221277-04Medicaid
TX276679YLPSOtherWELLMED PTAN
TX122127706OtherWELLMED MEDICAL GROUP PA - MEDICAID
TX1221277-04Medicaid