Provider Demographics
NPI:1376517284
Name:PORT, J TEIG (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:TEIG
Last Name:PORT
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 1:2822 N BELT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9321
Mailing Address - Country:US
Mailing Address - Phone:972-288-3331
Mailing Address - Fax:972-288-3340
Practice Address - Street 1:2822 N BELT LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9321
Practice Address - Country:US
Practice Address - Phone:972-288-3331
Practice Address - Fax:972-288-3340
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9393207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200041898OtherPALMETTO GBA
TX096417303Medicaid
TXD71887Medicare UPIN
TX8876B0Medicare PIN