Provider Demographics
NPI:1518372606
Name:PAUL R PORTER MD
Entity Type:Organization
Organization Name:PAUL R PORTER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-325-6446
Mailing Address - Street 1:934 S BROADWAY ST
Mailing Address - Street 2:STE 3
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1700
Mailing Address - Country:US
Mailing Address - Phone:615-325-6446
Mailing Address - Fax:615-325-2165
Practice Address - Street 1:934 S BROADWAY ST
Practice Address - Street 2:STE 3
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1700
Practice Address - Country:US
Practice Address - Phone:615-325-6446
Practice Address - Fax:615-325-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty