Provider Demographics
NPI:1508991613
Name:PORTER, WILLIAM HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARRIS
Last Name:PORTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2112
Mailing Address - Country:US
Mailing Address - Phone:319-385-4277
Mailing Address - Fax:319-395-4277
Practice Address - Street 1:307 W MONROE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2112
Practice Address - Country:US
Practice Address - Phone:319-385-4277
Practice Address - Fax:319-395-4277
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00594103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0264903OtherUBH ID
IA15821OtherBCBS OF NORTH DAKOTA
IA0264903Medicaid
IA42152563801OtherJOHN DEERE HEALTH
IAIP402272Medicare UPIN