Provider Demographics
NPI:1558379230
Name:PORTER, KRIS D (MD)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:D
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BLUFF VW
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4580
Mailing Address - Country:US
Mailing Address - Phone:512-800-3187
Mailing Address - Fax:855-813-9308
Practice Address - Street 1:251 WESTPARK WAY STE 210
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3742
Practice Address - Country:US
Practice Address - Phone:512-800-3187
Practice Address - Fax:855-813-9308
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102517308Medicaid
TX102517304Medicaid
TX102517305Medicaid
TX8G5192Medicare ID - Type UnspecifiedTARRANT COUNTY
TXG44331Medicare UPIN
TX102517305Medicaid
TX102517304Medicaid