Provider Demographics
NPI:1275588469
Name:PORTER RADIATION ONCOLOGY PA
Entity Type:Organization
Organization Name:PORTER RADIATION ONCOLOGY PA
Other - Org Name:RADIATION ONCOLOGY OF VENICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-485-2340
Mailing Address - Street 1:901 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3630
Mailing Address - Country:US
Mailing Address - Phone:941-485-2340
Mailing Address - Fax:941-485-5378
Practice Address - Street 1:901 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3630
Practice Address - Country:US
Practice Address - Phone:941-485-2340
Practice Address - Fax:941-485-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF1791OtherR.R.MEDICARE
DF1791OtherR.R.MEDICARE