Provider Demographics
NPI:1922536077
Name:PORTER, CHRISTOPHER BRENT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRENT
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 1:6750 CAROLINA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7052
Mailing Address - Country:US
Mailing Address - Phone:828-627-2211
Mailing Address - Fax:828-627-2216
Practice Address - Street 1:6750 CAROLINA BLVD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7052
Practice Address - Country:US
Practice Address - Phone:828-627-2211
Practice Address - Fax:855-876-9354
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202000676207Q00000X
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine