Healthcare Provider Details

I. General information

NPI: 1801886445
Provider Name (Legal Business Name): WILLIAM CALVIN PORTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S CASCADE ST STE 608
FERGUS FALLS MN
56537-2913
US

IV. Provider business mailing address

712 S CASCADE ST STE 608
FERGUS FALLS MN
56537-2913
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-8000
  • Fax: 218-739-6718
Mailing address:
  • Phone: 218-736-8000
  • Fax: 218-739-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5644
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number32055
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: