Provider Demographics
NPI:1760459747
Name:PORET, HARVEY ANDREW III (MD)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:ANDREW
Last Name:PORET
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1301 PLEASANT VALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7510
Practice Address - Fax:270-417-7529
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN280752086S0129X
KYTP765208G00000X
KY56864208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800546Medicaid
TNQ009578Medicaid
TN0111OtherJOHN DEERE
TN4029055OtherBLUESHIELD
TN3800542Medicare ID - Type Unspecified