Provider Demographics
NPI:1932687472
Name:PORTER, KARL ALAN
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:ALAN
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2310
Mailing Address - Country:US
Mailing Address - Phone:541-344-1121
Mailing Address - Fax:541-344-4210
Practice Address - Street 1:398 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2310
Practice Address - Country:US
Practice Address - Phone:541-344-1121
Practice Address - Fax:541-344-4210
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR50060118703Medicaid