Healthcare Provider Details

I. General information

NPI: 1811450356
Provider Name (Legal Business Name): DREW D PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

251 S CLAYBROOK ST STE A206
MEMPHIS TN
38104-3539
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-8699
  • Fax: 901-545-8996
Mailing address:
  • Phone: 901-516-7509
  • Fax: 901-516-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number63833
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: