Healthcare Provider Details

I. General information

NPI: 1609846393
Provider Name (Legal Business Name): PHILLIP P PORCH III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 WALLACE RD STE 206B
NASHVILLE TN
37211-4881
US

IV. Provider business mailing address

2801 CHARLOTTE AVE
NASHVILLE TN
37209-4035
US

V. Phone/Fax

Practice location:
  • Phone: 615-331-8281
  • Fax: 615-331-3043
Mailing address:
  • Phone: 615-250-9200
  • Fax: 615-250-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD13574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: