Provider Demographics
NPI:1235230574
Name:PORTER, THOMAS W III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:PORTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7830 MOONLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459
Mailing Address - Country:US
Mailing Address - Phone:281-431-3488
Mailing Address - Fax:281-431-4460
Practice Address - Street 1:927 SHAW AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-1430
Practice Address - Country:US
Practice Address - Phone:713-982-5900
Practice Address - Fax:281-431-9181
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2743207P00000X, 207R00000X
TXJ2742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51671Medicare UPIN