Provider Demographics
NPI:1205803541
Name:PORTER, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
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 1:1112 N. FLOYD RD.
Mailing Address - Street 2:STE 10
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-235-6911
Mailing Address - Fax:972-235-3285
Practice Address - Street 1:1112 N. FLOYD RD.
Practice Address - Street 2:STE 10
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-235-6911
Practice Address - Fax:972-235-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3930174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3930OtherSTATE LICENSE
TXH3930OtherSTATE LICENSE
TXH3930OtherSTATE LICENSE