Provider Demographics
NPI:1912017922
Name:PORTO, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:PORTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BORIS
Other - Middle Name:
Other - Last Name:PORTO, M.D., P.A.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 54136
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4136
Mailing Address - Country:US
Mailing Address - Phone:806-771-1386
Mailing Address - Fax:806-771-1388
Practice Address - Street 1:4412 74TH ST
Practice Address - Street 2:SUITE E102
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2328
Practice Address - Country:US
Practice Address - Phone:806-792-7843
Practice Address - Fax:806-792-7675
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH46212084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099191103Medicaid
TX00K82UOtherBCBS
TX8BN890OtherBLUE CROSS
TX099191101Medicaid
TX099191102Medicaid
TX121705101OtherFIRSTCARE
TX121705101OtherFIRSTCARE
TXF58585Medicare UPIN
TX099191103Medicaid