Provider Demographics
NPI:1134546864
Name:PORTER MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:PORTER MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOPARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-722-8283
Mailing Address - Street 1:24540 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4204
Mailing Address - Country:US
Mailing Address - Phone:832-326-8032
Mailing Address - Fax:281-354-8815
Practice Address - Street 1:24540 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4204
Practice Address - Country:US
Practice Address - Phone:832-326-8032
Practice Address - Fax:281-354-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty