Provider Demographics
NPI:1164456588
Name:PORTER, DEAN M (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:M
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:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65615
Mailing Address - Country:US
Mailing Address - Phone:417-335-7218
Mailing Address - Fax:417-334-1507
Practice Address - Street 1:251 SKAGGS ROAD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-335-7218
Practice Address - Fax:417-334-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030567207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
126814OtherBCBS
P00398195OtherRAILROAD MEDICARE
250766OtherHEALTHLINK