Provider Demographics
NPI:1114944048
Name:PORRATA, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:PORRATA
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:PO BOX 701950
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-1950
Mailing Address - Country:US
Mailing Address - Phone:210-981-1975
Mailing Address - Fax:210-614-1722
Practice Address - Street 1:312 FM 306 STE 108
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0301
Practice Address - Country:US
Practice Address - Phone:830-302-4260
Practice Address - Fax:830-214-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2206208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW920OtherBCBSTX
TX83983FOtherBCBS
TX134962307Medicaid
TX134962309Medicaid
TX8BW920OtherBCBSTX
TX8BW920OtherBCBSTX
TXD86937Medicare UPIN
TX83983FMedicare PIN