Provider Demographics
NPI:1225011513
Name:PORRAS, BEATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:
Last Name:PORRAS
Suffix:
Gender:F
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 643290
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0307
Mailing Address - Country:US
Mailing Address - Phone:513-631-0059
Mailing Address - Fax:513-631-0068
Practice Address - Street 1:9201 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7750
Practice Address - Country:US
Practice Address - Phone:513-631-0059
Practice Address - Fax:513-631-0068
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076667174400000X
OH35.076667207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459192Medicaid
IN200472230Medicaid
IN200472230Medicaid
OH2459192Medicaid