Provider Demographics
NPI:1407853104
Name:PORTER, CLARENCE MILTON (MD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:MILTON
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14100 NACOGDOCHES RD
Mailing Address - Street 2:STE 116
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1903
Mailing Address - Country:US
Mailing Address - Phone:210-653-8989
Mailing Address - Fax:210-590-4608
Practice Address - Street 1:14100 NACOGDOCHES RD
Practice Address - Street 2:STE 116
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1903
Practice Address - Country:US
Practice Address - Phone:210-653-8989
Practice Address - Fax:210-590-4608
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-10-18
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Provider Licenses
StateLicense IDTaxonomies
TXF3292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0994741-03OtherWELLMED MEDICAID
TX84V623OtherWELLMED MEDICARE
TX0994741-03OtherWELLMED MEDICAID