Provider Demographics
NPI:1134124894
Name:PORTER, SCOTT CRANSTON (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CRANSTON
Last Name:PORTER
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 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3194
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:
Practice Address - Street 1:4005 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1835
Practice Address - Country:US
Practice Address - Phone:806-792-2767
Practice Address - Fax:888-861-8858
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE61522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMX4996Medicaid
625920OtherFIRST HEALTH
TX129437304Medicaid
TX121695100OtherFIRSTCARE
300109572OtherRAILROAD MEDICARE
TX87466YOtherBLUE CROSS