Provider Demographics
NPI:1184681520
Name:PORTA, CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:PORTA
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 82
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-0082
Mailing Address - Country:US
Mailing Address - Phone:888-212-4243
Mailing Address - Fax:888-888-5688
Practice Address - Street 1:1600 11TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4300
Practice Address - Country:US
Practice Address - Phone:940-764-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5448207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9183OtherBLUE CROSS BLUE SHIELD
TX120677306Medicaid
TX930123202OtherMEDICARE RR PALMETTO
TX8G9183OtherBLUE CROSS BLUE SHIELD