Provider Demographics
NPI:1922047059
Name:PORTIS, BILL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:SCOTT
Last Name:PORTIS
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:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-1030
Mailing Address - Country:US
Mailing Address - Phone:731-407-7013
Mailing Address - Fax:
Practice Address - Street 1:14201 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38222
Practice Address - Country:US
Practice Address - Phone:731-407-7013
Practice Address - Fax:731-407-7019
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07989207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00231534OtherRAILROAD MEDICARE
TN3155502Medicaid
TN4099437OtherBCBS
TN3155502Medicare PIN
TNP00231534OtherRAILROAD MEDICARE
TN3155502Medicaid