Provider Demographics
NPI:1760676902
Name:R. WAYNE PORTER, M.D., P.A.
Entity Type:Organization
Organization Name:R. WAYNE PORTER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-563-6700
Mailing Address - Street 1:303 E COLLEGE ST STE A
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2700
Mailing Address - Country:US
Mailing Address - Phone:972-563-6700
Mailing Address - Fax:972-563-6656
Practice Address - Street 1:303 E COLLEGE ST STE A
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2700
Practice Address - Country:US
Practice Address - Phone:972-563-6700
Practice Address - Fax:972-563-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR09AOtherBCBS
TX00502TMedicare PIN