Provider Demographics
NPI:1639116221
Name:PORTER, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:600
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO418272085R0202X
NE251462085R0202X
KS04-363052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171543501Medicaid
NE10025709000Medicaid
MI104686310Medicaid
WY1639116221Medicaid
CA1639116221Medicaid
AZ49400746Medicaid
NE84-059792913Medicaid
AZ920555Medicaid
CO17205573Medicaid
KS200425430AMedicaid
KS111257018Medicare PIN
COCO304761Medicare PIN
COC504938Medicare PIN
NE10025709000Medicaid
COP00043784Medicare PIN
NENA2517051Medicare PIN
TX171543501Medicaid
WY1639116221Medicaid
COC802140Medicare PIN
NEP00796321Medicare PIN
CO17205573Medicaid
NENA1215033Medicare PIN
COC504918Medicare PIN
NE84-059792913Medicaid
KSKA3249051Medicare PIN