Provider Demographics
NPI:1174013726
Name:PORTER, RICHARD DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
Last Name:PORTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CRAWFORD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-4562
Mailing Address - Country:US
Mailing Address - Phone:817-408-3197
Mailing Address - Fax:817-579-3926
Practice Address - Street 1:1200 CRAWFORD AVE STE D
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-4562
Practice Address - Country:US
Practice Address - Phone:817-408-3197
Practice Address - Fax:817-579-3926
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9638204D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program