Provider Demographics
NPI:1245253970
Name:PORTER, DEBORAH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5305
Mailing Address - Country:US
Mailing Address - Phone:864-574-1841
Mailing Address - Fax:
Practice Address - Street 1:180 W WOODGLEN RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5305
Practice Address - Country:US
Practice Address - Phone:864-574-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56625207L00000X
SD22133207L00000X
GA054324207L00000X
ME015652207L00000X
WAMD00043589207L00000X
WI40364207L00000X
VA0101238225207L00000X
KY38920207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74893Medicare UPIN
MA3025152Medicare ID - Type Unspecified