MEDICARE: CLARENCE MILTON PORTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F3292	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	84V623	OTHER	TX	WELLMED MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407853104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE MILTON PORTER MD

Provider Business Mailing Address
First Line	:	14100 NACOGDOCHES RD
Second Line	:	STE 116
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1903
Country	:	US
Telephone Number	:	210-653-8989
Fax Number	:	210-590-4608

Provider Business Practice Location Address
First Line	:	14100 NACOGDOCHES RD
Second Line	:	STE 116
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1903
Country	:	US
Telephone Number	:	210-653-8989
Fax Number	:	210-590-4608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/18/2016

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Directions to “ CLARENCE MILTON PORTER MD” Practice Location

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