Provider Demographics
NPI:1508008947
Name:PORTER, CLIFFORD FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:FREDERIC
Last Name:PORTER
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 1:1000 E 41ST ST STE 925
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4856
Mailing Address - Country:US
Mailing Address - Phone:512-978-9940
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST STE 925
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-978-9940
Practice Address - Fax:512-901-9702
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34828207Q00000X
TXQ4495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine