Provider Demographics
NPI:1528001344
Name:PORTER, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
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 1:1407 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6606
Mailing Address - Country:US
Mailing Address - Phone:405-329-4304
Mailing Address - Fax:405-366-8993
Practice Address - Street 1:1407 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6606
Practice Address - Country:US
Practice Address - Phone:405-329-4304
Practice Address - Fax:405-366-8993
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13650173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123490AMedicaid
OK100123490AMedicaid
OK100123490AMedicaid