MEDICARE: JANE WOFFORD PORTER AUD

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	231H00000X	Audiologist	50248	TX

General Provider Information

NPI Number	:	1992708937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE WOFFORD PORTER AUD

Provider Business Mailing Address
First Line	:	800 W AIRPORT FWY
Second Line	:	STE 118A
City	:	IRVING
State	:	TX
Zip	:	75062-6313
Country	:	US
Telephone Number	:	972-438-9360
Fax Number	:	972-554-8767

Provider Business Practice Location Address
First Line	:	800 W AIRPORT FWY
Second Line	:	STE 118A
City	:	IRVING
State	:	TX
Zip	:	75062-6313
Country	:	US
Telephone Number	:	972-438-9360
Fax Number	:	972-554-8767

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/30/2008

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Directions to “ JANE WOFFORD PORTER AUD” Practice Location

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