Provider Demographics
NPI:1669652665
Name:PORTER, CHAD THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:THOMAS
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 1:6 PALOMA BEND PLACE
Mailing Address - Street 2:
Mailing Address - City:WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:713-818-7481
Mailing Address - Fax:
Practice Address - Street 1:2106 LOOP RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3344
Practice Address - Country:US
Practice Address - Phone:318-435-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP12112085R0202X
LAMD.2016182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANPIOther1669652665
LA201618OtherLICENSE
LA35010OtherCDS
2085R0202XOtherTAXONOMY
LA1217077Medicaid
LA1217077Medicaid
LA35010OtherCDS