Provider Demographics
NPI:1801886445
Name:PORTER, WILLIAM CALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CALVIN
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:STE 608
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-739-6718
Practice Address - Street 1:712 S CASCADE ST
Practice Address - Street 2:STE 608
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2913
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-739-6718
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5644207Y00000X
MN32055207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2T996POOtherBCBS MN
MN089790600Medicaid
ND11830OtherBCBS ND
ND16002Medicaid
ND11830OtherBCBS ND
MN089790600Medicaid