Provider Demographics
NPI:1164671608
Name:PORAT, SHIMSHON (MD)
Entity Type:Individual
Prefix:
First Name:SHIMSHON
Middle Name:
Last Name:PORAT
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 1:429 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4749
Mailing Address - Country:US
Mailing Address - Phone:256-241-2671
Mailing Address - Fax:256-241-2676
Practice Address - Street 1:429 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4749
Practice Address - Country:US
Practice Address - Phone:256-241-2671
Practice Address - Fax:256-241-2676
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-08886OtherBCBS OF AL
AL122020Medicaid
TN3002438Medicare PIN